Supra-microsurgery for treating lymphedema

Conservative treatment consisting of manual lymphdrainage and compression therapy is the cornerstone. Unfortunately, this treatment for lymphedema does not address the cause of the problem namely the disruption or obstruction of the outflow of lymphatic fluid through lymphatic vessels from the affected area towards large central lymphatic vessels. Also, compressive bandaging is not a user-friendly option for lymphedema manifestating in the face, breast, hip or scrotum.

Supra-microsurgery can tackle the obstructed outflow of lymphatic fluid from the affected area in lymphedema patients.

By means of a connection between veins and lymphatics, or a lympho-venous anastomosis, lymphatic fluid can drain into the venous system while the damaged area is bypassed.

It is indeed well known that disruption of the lymphatic flow e.g. due to cancer treatment, results in dysfunction of the lymphatic vessels and leads at long-term to lymphatic vesssel sclerosis. This proces is unfortunately irreversible.

Lympho-venous anastomoses are made between lymphatic vessels and adjacent veins, both often smaller than the size of a hair, resulting in a newly formed route for the lymphatic flow. This minimally invasive intervention is carried out through small skin incisions of 2-3 cm in length and is performed under loco-regional anesthesia.

Supra-microsurgery requires high magnification microscopes, specialised instruments and a longstanding technical expertise.

Lympho-venous anastomoses are an effective treatment option for patients with established lymphedema and are in particular a good treatment option for patients with lymphedema at areas that are difficult to treat with compression garments, such as the scrotum, the hip and the breast. Dr Giacalone was the first to treat a case of breast cancer-related breast lymphedema by supra-microsurgical lympho-venous anastomosis. Lympho-venous anastomoses are also effective as a treatment for lymphocele or lymphatic leakage.

Although lympho-venous anastomosis is a well-established treatment option for patients with lymphedema, only few centers in the world have the expertise to successfully perform this type of supra-microsurgery.