Loop electrosurgical excision procedure (LEEP) under local anesthesia: a retrospective analysis of 435 subsequent cases under a quality assurance program.

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The aim of this study is to analyze a quality assurance program regarding the switch from loop electrosurgical excision procedure (LEEP) in general anesthesia (GA) to local anesthesia (LA) regarding patients' perioperative pain levels, patients´ satisfaction, as well as resection margins. We performed a single-center retrospective analysis of our quality assurance program including all patients undergoing LEEP at the Department of Obstetrics and Gynecology, Ordensklinikum Linz and Konventhospital Barmherzige Brueder Linz, from January 2021 to June 2024. 435 patients were questioned postoperatively after being treated with LEEP in LA regarding the perioperative pain as measured by a numeric rating scale (NRS) and patients' satisfaction. Clinical data were collected from the patients' electronic chart to investigate further parameters. Mean perioperative pain levels were stated as 1.3 (1.9). Five perioperative complications were reported. In seven out of 435 cases (1.6%) an inpatient readmission or a revision surgery under GA had to be performed. A R0 resection rate of 81.4% could be achieved. In 9.7% and 8.3% a R1 resection rate was reported on the ectocervix and on the endocervix, respectively. 95.3% of patients would choose LEEP in LA as their preferred method of anesthesia for a possible subsequent surgical LEEP procedure. Our study showed that the implementation of LEEP in LA was successful at our department as a new standard of care, resulting in a high R0 resection status and a high level of patients' satisfaction. We encourage physicians and organizations to switch from GA to LA when performing LEEP for cervical dysplasia.