Surgical Treatments for Lymphedema (@Stanford)
Surgery is a treatment option for a very small, selected percentage of the patients who have lymphedema.
The two categories of surgical intervention that are currently available in the United States are
lymphatic reconstruction and
excisional surgeries
Lymphatic Reconstruction
- Lymph node transplant is surgery in which lymph nodes are moved from one part of the body (usually the abdomen) to the lymphedema affected area. The transplanted lymph node theoretically stimulates the growth of new lymph channels into and out of the transplanted node.
- Anastamotic reconstruction attempts to restore lymph flow through a surgical re-joining of the damaged lymph channel either to another lymphatic vessel or to a vein.
- Debulking is surgery that involves the surgical removal of excess tissue that hangs in folds.
- Liposuction is an excisional operation during which a tube is inserted under the skin. Through this tube, a high-pressure vacuum is applied to break up and "suck out" excess fat cells. This procedure often leaves excess skin hanging loose.
Because most of the observations of outcomes from lymphatic reconstruction for lymphedema are limited in scope and duration of follow-up, these procedures are not actively practiced in our institution. A significant potential for risk exists, including unexpected worsening of the lymphedema, failure to improve the original condition, and scarring complications of the surgical intervention. In lymph node transplantation, there is a finite risk that lymphedema could also develop in the region of the body from which the transplanted lymph node is harvested.
Excisional Surgeries
- Debulking is a surgical intervention that removes large excesses of skin and soft tissue overgrowth; which occurs as a complication of longstanding lymphedema
- Liposuction is a specialized adaptation of the procedure that permits the surgeon to remove overgrown fatty tissue that resides under the skin. This can become necessary in lymphedema because of the tendency for fatty overgrowth to commonly occur when lymphedema is chronic. In properly selected patients, the lymphedema limb can be restored to normal size through surgery. The operation is performed under general anesthesia, but is minimally invasive. The surgical technique has been perfected in Europe over the past two decades and now has an extensive documentation of efficacy without complications or untoward outcomes.
Both forms of excisional surgery are performed, for properly selected patients, in our center.
http://stanfordhospital.org/cardiova...s/surgery.html
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