Lymphatic Reconstruction Surgery
The lymphatic system is a term used to describe the network of fluid, cells, vessels and nodes that maintain the body's immune system, fluid balance and cholesterol metabolism. If the lymphatic system is damaged, it can lead to lymphedema, which is the pooling of lymphatic fluid in one part of the body. This causes swelling and possibly discomfort, and infections in the affected area. Sometimes the lymphedema can be controlled with pressure dressings, or lymphatic drainage massage. Historically they only operations available were liposuction and debulking operations. Fortunately, with the improvements in microscope technology and surgical technique there are surgical options available to reconstruct the lymphatic system, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfers (VLNT).
What is the lymphatic system?
Lymphaticovenous Anastomosis (LVA)
LVA is a microscopic procedure that involves connecting lymph vessels to blood vessels. This allows excess lymph to drain directly to the venous system facilitating more efficient lymph drainage from the swollen limb. This functions to reduce swelling and other lymphedema symptoms. LVA can be used to treat mild to moderate lymphedema in the arms or legs.
The LVA procedure is minimally invasive. It small shallow incision is made in the affected limb. Using a high powered microscope and specialized instrumentation lymphatic vessels are identified and attached to neighboring veins. The surgery can be performed under local anesthesia, and patients almost always return home the same day. Recovery time is negligible, most patients resume normal activities within a few days.
VLNT is a more invasive surgical procedure it involves transplanting healthy lymph nodes, from a distant part of the body to the affected limb. In our practice these lymph nodes are taken from the abdominal cavity. This is done to prevent a new lymphadematous body part. The transplanted lymph nodes to act as a new drainage system. The result is improved lymphatic flow and reduced swelling. VLNT is used to treat more severe cases of lymphedema, that have not responded to other treatments.
VLNT involves a laparoscopic harvest of lymphy nodes from the abdominal cavity. Once a suitable donor site for the lymph nodes is identified. The lymph nodes carefully transplanted to the affected limb, where their blood vessels are connected to blood vessels in the limb. The surgery is performed under general anesthesia, and patients typically need to stay in the hospital over night. Recovery time is longer than LVA, with most patients needing a couple of weeks to fully recover.
Vascularized Lymph Node Transfer (VLNT)
Both LVA and VLNT are options for reconstructing the lymphatic system and treating lymphedema. While both of these operations are low risk. All surgical procedures, have nonspecific potential risks such as infection, bleeding, scarring, and nerve damage.
The potential benefits of lymphatic reconstruction life changing. Many patients experience reduced swelling and a reduction in other lymphedema related problems as well. The success rate of these procedures varies depending on several factors, including the severity of the lymphedema and the patient's overall health.