LLETZ procedure / cone biopsy

What is LLETZ?

LLETZ (or large loop excision of transformational zone) is a procedure where a small piece of cervix (neck of womb) is removed by diathermy (an electric current). Cone biopsy is the excision of the end of the cervix with a knife.

It can be done under local or general anaesthesia.

How it’s done?

The procedure last about 15 minutes, and you are expected to be ready to return home within a couple of hours.

During the procedure a small piece of cervix is cut, and the base is burnt or stitched in placed to stop bleeding. The tissue is then sent for histological evaluation to determine whether any further treatment is needed.

The recovery

After the procedure you may experience some mild abdominal cramping and dark discharge from the vagina. Over the next few days a crust which has formed on the cervical base may fall off and you may experience a bloody discharge that may persist over the next few weeks. If you experience increasing abdominal pain, heavy bleeding or fevers, you should contact your doctor. Upon discharge you will be given simple analgesia and you will be advised to avoid swimming, sexual intercourse and using tampons over following 4 weeks to minimise risk of infection.

A follow up appointment will be organised for you.

What are the risk factors for LLETZ?

There are possible complications to this procedure:

• Bleeding, occasionally requiring a return to theatre to place sutures over the bleeding area.
• Infection, requiring antibiotics.
• Damage to the cervix (narrowing of the canal can lead to painful periods; treatment is the widening of the canal with special instruments).
• Cervical weakness, where the cervix is unable to support a growing pregnancy, and late term miscarriage or preterm labour may occur.
• Incomplete excision of abnormal area of cervix, sometimes needing another procedure to remove all abnormalities.
• New abnormalities may occur after the procedure.
• General risk to surgery such as lung collapse or infection, blood clot formation in leg (DVT) or lung (PE), heart attack or stroke.