Lymphedema_surgery-1920x760

Lymphedema surgery

Surgeries for lymphedema treatment can be considered in several cases: conservative (non-surgical) treatments have failed, when severe swelling occurs, or to remove excessive tissue after successful decongestion therapy.

The gold standard for lymphedema treatment is Complex/Complete Decongestive Therapy (CDT), which combines conservative (non-surgical) treatments like Manual Lymphatic Drainage (MLD) and compression therapy.

Surgical options may be explored if conservative therapies fail to adequately address lymphedema symptoms. Usually, therapy with compression garments is continued after the surgery for a specific time.

Surgery may also be necessary in the following cases:

  • Severe swelling and deformities
  • Excessive soft tissue after successful decongestion therapy
  • Recurrent cases of bacterial cellulitis
  • Lymphedema at the eyelid or genitals
  • Long-term complications, such as lymphangiosarcoma
  • Connections between the lymphatic system and the skin (lymphocutaneous fistula)

What are the types of lymphedema surgery?

Depending on the reason for surgical therapy, there are different types of lymphedema surgery:

  • Microsurgery to reconstruct the lymphatic system
  • Surgical reduction to remove excessive tissue (debulking)
  • Liposuction to remove the fatty tissue and to improve the limb shape and size

Microsurgery

There are different types of microsurgery, but all aim to reconstruct the lymphatic system. Before microsurgery, the function of your lymphatic system has to be visualized. For this purpose, a small amount of fluorescent dye is injected into your lymph vessels. The lymph flow transports the dye and gives a picture of your lymphatic system and its function. Here is a brief description of how microsurgery can reconstruct the lymphatic system:

Lymph vessel transplantation:
Well-working lymph vessels from your body are transplanted to the area with non-working or missing lymph vessels.

Lymph node transplantation:
Well-working lymph nodes from your body are transplanted to the area with non-working or missing lymph nodes, together with their surrounding tissue.

Interposition of veins:
A vein of your body is used to build a bridge between your lymph collectors to improve lymphatic drainage. This technique can be used to restore the lymph passage when the lymphatic flow is blocked.

Lymphatic-venous and lymphonodulo-venous anastomosis:
Anastomosis is the medical term for a connection between two structures. Surgeons create a local connection between the lymph vessels and a vein (lymphatic-venous anastomosis) or a lymph node and a vein (lymphonodulo-venous anastomosis). The technique aims to improve the drainage of the lymphatic flow.

lympedema-surgery-1-800x640

Surgical reduction

Surgical reduction may be necessary after successful decongestion therapy to remove excessive tissue and improve the limb's shape. It is also an option for patients with lymphedema at the eyelid or external genitals or to reduce the symptoms of severe lymphedema.

Liposuction

Liposuction for lymphedema patients aims to remove the fatty tissue and to improve the limb shape and size. It does not treat your lymphedema itself and does not improve lymphatic drainage. Liposuction usually requires general anesthesia, and you will probably spend a few days in the hospital. Before and after liposuction, compression therapy is vital to ensure the therapy's long-term success.

Bariatric surgery

Secondary lymphedema can develop from obesity, and obesity can also impair existing lymphedema. Bariatric surgery may be an option for certain patients with difficulties losing weight.

What are the risks of lymphedema surgery?

The different surgical options all have their risks. Some general risks can occur after all types of lymphedema surgeries, such as infections, bleeding, or damage to the nerves and vessels during surgery. Lymphedema surgeries are not suitable for every lymphedema patient. If you want to know more about surgical treatments for lymphedema, a discussion with your Healthcare Professional is recommended.

Funding

Before considering surgery, consult your Healthcare Professional to determine if it's suitable and beneficial for you. Additionally, inquire about potential coverage for surgery costs with both your Healthcare Professional and health insurance provider, as coverage may vary.

Expand your knowledge