New Modifications of the Loop Electrosurgical Excision Procedure (LEEP) for the Management of Cervical Lesions in The Low Resource Conditions

Amal Abdulrahman Al-Kbous, Visitor of Obstetrics and Gynecology, Mansoura University Hospital, Faculty of Medicine, Mansoura University, EgyptFollow
Rafik Ibrahim Barkat, Professor of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt.
Mohamed A. Elnegeri, Professor of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt.
Amany A. Makroum, Lecturer of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt.
Reda Abdelhadi Hemida Dr.Reda Hamida, Professor of Obstetrics and Gynecology, Faculty of medicine, Mansoura University Hospital, EgyptFollow
Mohamed Elsayed Taman, Assistant professor of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt.

Subject Area

Obstetrics & Gynaecology

Article Type

Original Study

Abstract

Background: Cervical intraepithelial neoplasia (CIN) encompasses a range of abnormal changes within the cervical squamous epithelium and is regarded as a precursor to invasive squamous cell carcinoma of cervix. Management of CIN-1 generally involves follow-up with repeat testing after one year, while CIN-2 and higher lesions require treatment aimed at complete removal of the lesion and transformation zone using ablative or excisional methods such as Loop electrosurgical excision (LEEP), or cold-knife cone biopsy. This study aimed to test applying a new modification on LEEP to facilitate its use in the management of cervical lesions in the low resource conditions regarding its effectiveness, safety, feasibility and short-term sequels. Methods: This study was a prospective cohort study conducted on 30 patients with either confirmed cervical intraepithelial neoplasia or highly suspicious cervical lesions, required a more diagnostic biopsy for exclude malignancy. Primary screening was conducted using Visual Inspection with Acetic Acid (VIA). Colposcopy was conducted for all VIA-positive cases. Cervical biopsies were taken from suspicious areas identified either visually or under colposcopic guidance, using Tischler forceps, and postoperatively (via LEEP). The evaluated primary outcomes comprised the procedural effectiveness measured by the success and failure rates of complete excision of the lesions and the level of surgeon satisfaction. Results: The patients’ ages ranged from 28–50 years (mean ± SD = 37.8 ± 6.73 years). Postcoital bleeding (60%) were the most common presenting symptoms followed by and vaginal discharge (23.3%). More than 70% of surgeons rated the technique as “satisfied” or “very satisfied” , while only a small minority reported neutral or unsatisfied responses. There was a downgrading of CIN grades postoperatively, with decreased CIN1 and CIN3 cases, while two cases showed upgrading—one from chronic cervicitis to CIN1 and another from CIN3 to invasive carcinoma, the latter being excluded from follow-up per predefined criteria. On follow up, 26 patients achieved complete excision of the lesion (no residual disease) with complete healing, whereas 3 patients demonstrated residual or recurrent lesions associated with poor or absent healing. Conclusion: The new modifications to the LEEP approach achieved a high success rate (89.7%), with minimal intraoperative complications. So, modified LEEP technique is a safe and effective alternative in low-income healthcare settings.

Recommended Citation

Al-Kbous, Amal Abdulrahman; Barkat, Rafik Ibrahim; Elnegeri, Mohamed A.; Makroum, Amany A.; Hemida, Reda Abdelhadi Dr.Reda Hamida; and Taman, Mohamed Elsayed (2025) "New Modifications of the Loop Electrosurgical Excision Procedure (LEEP) for the Management of Cervical Lesions in The Low Resource Conditions," Mansoura Medical Journal: Vol. 55 : Iss. 1 , Article 10.
Available at: https://doi.org/10.58775/2735-3990.1500