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Electroconization of the cervix (LLETZ)

Dr. Dilyana Atanasova

Dr. Atanasova graduated from Medical Faculty of the Medical University of Sofia in 2001. In 2009 she acquires specialty in Obstetrics, Gynecology and Repoductive health at the Obstrics and Gynecology department of the Medical University of Sofia. In 2017 she completes a dissertation "Evaluation of the contemporary methods for detecting precancerous changes of the cervix".

Dr. Dilyana Atanasova has been part of MC MARKOVS team since 2010.


Electroconization of the cervix (LLETZ)

What is LLETZ?

Electroconization of the cervix (LLETZ - Large Loop Excision of Transformation Zone) is a diagnostic and therapeutic procedure during which a cone-shaped piece of the cervix is excised with the help of a special electroloop (loop electrode).


When is LLETZ necessary?

The up to date approach in prevention of cervical cancer includes the early detection and treatment of its precancerous lesions (precancerous changes or the so-called cervical intraepithelial neoplasia - CIN). In the presence of a positive result from a previously performed cytological or colposcopic screening, a targeted biopsy is usually performed. When the histological result  is CIN, various treatment methods are possible, one of which is electroconization of the cervix (LLETZ) .


How does electroconization work?

The procedure is done under local or general anesthesia by a specialist in Gynecology. It is performed without special preparation of the patient during the first days after menstruation. After speculum is inserted in the vagina a strict disinfection is obtained and a cone-shaped piece of the cervix is excised with a loop electrode. Another piece of tissues is taken from the bottom of the wound using a smaller electrical loop so that the pathologist is able to determine whether the atypical CIN positive area is completely removed. The  materials are sent for histological examination. LLETZ is a procedure associated with minimal blood loss and the duration of the manipulation is between 15 and 30 minutes.


Are there any contraindications for performing LLETZ?

The procedure is contraindicated in case of blood clotting difficulties or intake of anticoagulants (Aspirin, Heparin,
Fraxiparin, Coumarin derivatives, etc.). Pregnancy is also a contraindication for electroconization, excepting the cases where a invasive malignant process is suspicted.

What is important to have in mind after LLETZ?

Usually the patients stay for about half an hour for observation and recovery, then they can carry out their usual daily routines. During the days after  the procedure there might be a grayish or brownish vaginal discharge with signs of blood, which will decreases in the next days. Mild menstrual-like pain or vaginal burning are possible within the first 1-2 days. Certain restrictions have to be observed until the next period: vaginal douches and tampons are not to be used; swimming pools, bathtubs and intercourse have to be avoided so that the cervical tissue heals.

Recovery time after LLETZ

Three months after the electroconization an examination is done to evaluate the effect of the manipulation and recovery of the cervix. There is some minor risk for preterm birth in future pregnancies. A cerclage (prophylactic suturing of the cervix) is recommended in these cases.