Is a LEEP like cryrosurgery?

[mustangsally65]

I'm referring to the procedures used to remove/destroy dysplasia of the cervix.

What are the differences? Is one more favorable than the others?

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[daisyduke]

The difference is in the procedure itself. I think the LEEP, cold knife cone, and cryoablation are all similar effectiveness... but I dont know the literature to back that up, just what I learned in gyn onc clinic. LEEP involves using a metal loop on the end of an electrocautery device (like a bovie with a loop instead of just a metal point) to sweep through the cervix and remove an outer chunk including the transformation zone. It is performed in the office using local anesthetic. CKC is done in the OR using a knife to cut out a little cone around the os which also removes the transformation zone. Cryotherapy freezes off the specific area of dysplasia-- haven't actually seen this done myself, do I don't know too much about it. Hope that helps!

 

[obgyn06]

the LEEP can also be done in the OR depending on patient and physician preference. One of the advantages of LEEP over cryo is that you get actual pathology. They can look and see how bad the dysplasia actually was and if the margins were clear. With cryo, you don't get pathology. However, with cryo you do tend to preserve more of the cervix than with the LEEP. Most physicians perform LEEP over cryo these days. Additionally, cryo is only used for CIN 1 that is persistant or CIN 2 with a negative ECC. But, like I said, I think most physicians feel more comfortable with a LEEP and getting pathology.

 

[mustangsally65]

Thanks for the info! I can see the pathology advantages of LEEP.

What are differences as far as outcome or recovery? Is one more painful than the other? Is one more expensive? Does removing part of the os affect future ability to deliver children?

Most of the stuff I read when I do a google search is patient information and what to expect, which doesn't apply to me and doesn't answer my questions. With the recent HPV vaccine articles I was wondering what future implications these procedures might have.

 

[obgyn06]

Thanks for the info! I can see the pathology advantages of LEEP.

What are differences as far as outcome or recovery? Is one more painful than the other? Is one more expensive? Does removing part of the os affect future ability to deliver children?

Most of the stuff I read when I do a google search is patient information and what to expect, which doesn't apply to me and doesn't answer my questions. With the recent HPV vaccine articles I was wondering what future implications these procedures might have.

Well recovery mostly depends on whether or not you decide to go to the OR for the leep. If you did, than the recovery would be from the anesthesia. After that, the recovery is similar. 4-6 weeks with nothing in the vagina. You would have some bleeding from the LEEP but some funky discharge from the cryo that will last a couple of weeks. As far as pain, I'm not sure but my guess is they are comparable. If a LEEP is done in the OR...well than it is painless. If in the office, they do a paracervical block and then do the procedure. I have heard that it is less painful than a colpo with biopsy. I've never seen cryo done, but I don't think they do a block - they just do the freezing. And it is quick. but painful i'm guessing. I don't know if one is more expensive. Obviously going to the OR would be more $$. If i were going to get a LEEP i would want to go to the OR though. As far as most people can tell, 1 single LEEP has a very small likelihood of affecting future pregnancies. The issue would be with cervical incompetence. It is more likely to happen in someone that has multiple LEEPs or a cold knife cone. The LEEP is newer technology than cryo. The risks are comparable and the risk of cervical incompetence is really minimal. If it were me, I would get a LEEP and just be done with it. (in the OR though!) 🙂

Well the HPV vaccine will take many years to have a significant impact on pap smears and cervical dysplasia. The vaccine will only be effective for those people that do not already harbor the virus. This population is mostly going to be young, virgin females. Most of the rest of the population that is sexually active will not benefit from the vaccine because most people have already gotten or been exposed to the virus. So when those young girls become sexually active in 10-30 years, then we will see *some* impact. But there are still plenty of women that are 16 years old and older that have the virus and will be dealing with it for some time. I.E. in 30 years when that 16 y.o. is 46 and has dysplasia. I believe it will be a LONG time before we see the true impact and decreasing numbers of dysplasia.

 

[Alician]

Do you have access to the green journal? (Obstetrics and Gynecology) There is a retrospective cohort study Feb 2005 that while not an RCT, addresses this issue. What I took away from it is that there might be increased risk of future preterm delivery with conization procedures such as LEEP, that there was no differnence in neonatal outcome. Also, it likely depends on length of the cervix pre-procedure.

Additionally, don't forget about laser ablation or laser cone.

I would personally get some type of ablation if it was my first procedure just to be extra safe. However, this requires a satisfactory colpo and a first time diagnosis, not a recurrence after an original ablative therapy.

Also, when I have seen LEEPs done in the past, a paracervical block was not used and patients seemed to tolerate the procedure well.

-Ali

Thanks for the info! I can see the pathology advantages of LEEP.

What are differences as far as outcome or recovery? Is one more painful than the other? Is one more expensive? Does removing part of the os affect future ability to deliver children?

Most of the stuff I read when I do a google search is patient information and what to expect, which doesn't apply to me and doesn't answer my questions. With the recent HPV vaccine articles I was wondering what future implications these procedures might have.[/QUOTE]