Surgery

There are a few options for surgery for lymphoedema however, they depend on the stage and cause of the lymphoedema, as well as several other factors.  Surgical treatment for lymphoedema is considered to be an alternative or supplement to the mainstay of treatment for lymphoedema. Surgery includes constructing an alternative lymph drainage route away from the obstruction(s). Some surgical procedures require the continued use of the mainstay of treatment for lymphoedema (such as compression therapy) either prior to or post-surgery.  Surgery is not suitable for everyone with lymphoedema and a discussion with a lymphoedema specialist is recommended. There is a lot to consider and a clear understanding of the anticipated outcomes post-surgery is important. 

Surgical treatment for those with lymphoedema includes microsurgery and liposuction. As with any surgery or treatment, a thorough assessment is required by a trained healthcare professional. If you want to know more about surgical treatments for lymphoedema, including any associated risks and complications, a discussion with your healthcare professional and a surgeon is recommended. 

Microsurgery and Super-microsurgery

The aim of reconstructive microsurgical or super-microsurgical procedures is to improve lymphatic function and limb shape. Prior to surgery, other investigations are necessary to provide a visual of the lymphatic function to determine, among other things, the level of lymphatic function. This is usually achieved through Indocyanine Green (ICG) lymphography. ICG is a green coloured fluorescent dye. A tiny amount of this dye is injected into the affected area and the uptake of the dye by the lymphatics is monitored. 

Main microsurgical and super-microsurgical options

  • Lymphaticovenular Anastomosis (LVA) is performed under local anaesthetic and considered to be minimally invasive. The aim is to find an alternative drainage route for the lymphatic fluid by directing it away from the damaged area(s) and directly back into the circulation system. The lymphatic channels are located, and tiny incisions are made in the skin to connect these to small veins just below the skin’s surface. LVA is considered to be most relevant to those with secondary lymphoedema of the limbs.
  • Lymph-Node Transfer (LNT) is more invasive than LVA as it requires a general anaesthetic. Lymph nodes are taken from unaffected areas of the body and transplanted to the affected (swollen) area.

Liposuction 

For some (but not all), with long-standing lymphoedema, tissues changes may develop in the swollen area. The area may become more fatty and rubbery in appearance. The swelling is not ‘pitting’ [add link to definition] as it no longer leaves a visible indentation when pressed with a finger and there is no sign of swelling reduction after elevation. In addition, the swelling may also stop responding to compression therapy (for example, compression garments) and other aspects of treatment. For a few experiencing this type of change, liposuction may be an option.

Liposuction for lymphoedema is different to that offered for cosmetic indications. The aim for those with lymphoedema is to remove the excess fatty (adipose) tissue and restore limb shape and size. Liposuction procedures for lymphoedema usually require a general anaesthetic followed by a few days stay in hospital. Through tiny incisions in the skin, suction is applied to remove excess fatty tissue from the swollen area. 

Compression therapy is required both prior to and post-surgery with possibly a period of 24 hours wear and regular reviews of the compression to ensure it is accommodating any reduction in limb size. Compression, along with other elements of care, is required to maintain the results of the surgery and to continue to manage the lymphoedema long-term. 

Click here to read the NICE guidance ‘Liposuction for Chronic Lymphoedema’. 

Bariatric Surgery

For those that have developed lymphoedema as a result of obesity and struggle to lose weight using conservative methods, bariatric surgery may be an option. It will not address the lymphoedema (or swelling) itself but aims to help manage obesity. 

Funding

Surgical options for lymphoedema are not usually available on the NHS however, there are some private clinics offering surgery. 

Further support

Not everyone is suitable for surgery and results vary depending on several factors. It is important that you discuss what is involved, any risks / complications and anticipated outcomes with your lymphoedema specialist to make an informed decision about your care.