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Large loop excision of the transformation zone (LLETZ)

What is a LLETZ?

LLETZ stands for large loop excision of the transformation zone. This procedure will remove a small segment of the cervix (the lower part of your womb or uterus).

What is a cone biopsy?

A cone biopsy is a less common surgical procedure where a cone-shaped or cylinder-shaped piece of the cervix is removed.

Why are they performed?

These procedures are performed for the diagnosis and treatment of pre-cancerous cells of the cervix. You should have a clear understanding of your reason for this surgery—if not, please ask your doctor.

What are the altermatives?

A LLETZ or a cone biopsy are recommended in order to treat pre-cancer cells. If you chose not to undergo treatment, there is a strong likelihood that these changes would progress to cancer over some years. If you did not have treatment it would be essential for you to have ongoing close follow-up in the colposcopy clinic.

How are they performed?

The procedure is usually performed under a local anaesthetic. The cervix is examined using a special microscope called a colposcope (in the same way as you were examined in the Gynaecology Clinic). A fine wire loop charged with electricity is used to shave away the abnormal tissue from the cervix. Because the procedure is so exact, and the loop very thin, very little damage is done to the tissue surrounding the area that needs to be removed. The procedure allows for the blood vessels surrounding the area to be sealed. A cone biopsy is more commonly performed under a general anaesthetic. The abnormal cells are often cut out with a knife. Dissolvable sutures are used to stop the bleeding. Both procedures take approximately fifteen minutes or more.

What are the risks of undergoing this procedure?

Although the risks associated with a LLETZ procedure or a cone biopsy are low, you should be aware that every surgical procedure has some risk.

There are some specific risks to be aware of in relation to this operation:

  • Excessive bleeding from the cervix, which may need blood transfusion or further surgery, either initially or within weeks of the procedure.
  • Infection may be introduced into the cervix, uterus, tubes or abdomen. This may require treatment with antibiotics.
  • Sometimes not all of the abnormal tissue is completely removed, requiring further surgery
  • Uncommonly, the cervix may be weakened by this procedure resulting in a slight increase in the future pregnancy risk of a late miscarriage or preterm birth.
  • Rarely the cervix may be damaged and narrowed leading to painful periods, difficulty in performing adequate pap smears, or problems in the progress of a future labour.

What should I do before the procedure?

  • Any tests or referrals arranged at your outpatient stage should have been completed.
  • You should continue your regular medications, unless advised otherwise.
  • Stop smoking.
  • Should you develop an illness prior to your surgery, please contact the Gynaecology Case Manager immediately.

What should I do on the day of the procedure?

Unless otherwise specified, you should stop eating and drinking at the following times on the day of the surgery:

  • at midnight for a morning procedure
  • at 6 am for an afternoon procedure.

You should continue all your usual medications, unless otherwise specified. You should shower and remove any body jewellery.

You should bring:

  • toothbrush / paste / toiletries
  • nightgown
  • underwear
  • sanitary pads
  • all usual medications
  • all X-rays.

What should I expect after the procedure?

You should be able to leave the hospital that day. You will be given specific discharge medication if required, but you may use paracetamol or paracetamol-codeine as required (one to two tablets every four hours up to a maximum of eight tablets per day). You should expect a bloody vaginal discharge for several days after the procedure, which should settle within one to two weeks. A clear discharge may persist for up to six weeks. You should be able to return to work the following day, but may require more time off work, depending on the procedure performed. Follow up appointments are very important to ensure that all of the abnormal cells have been removed.

After discharge from hospital, you should:

  • eat and drink normally
  • remain mobile
  • use sanitary pads (not tampons) if required
  • shower normally (in preference to bathing).

You should not:

  • have intercourse for four weeks

What if I have any problems?

You should seek medical attention if you experience:
  • fever or feeling unwell
  • offensive vaginal discharge or heavy bleeding
  • severe pain.

Please contact our Gynaecology Case Manager or attend Mater Emergency Department if you require urgent attention.