Microsurgery for management of primary and secondary lymphedema: First experience in Israel.

OBJECTIVE: To evaluate the efficacy and safety of lymphaticovenular anastomosis in patients with lymphedema.

METHODS: Retrospective analysis of 70 patients suffering from primary or secondary extremity lymphedema who underwent lymphaticovenular anastomosis surgery with indocyanine green fluorescent lymphangiography. Postoperative evaluation included qualitative and quantitative volumetric assessment and analysis. Limb volume was measured using circumferential tape measurement volumetric method, in which the limb is subdivided into 5 segments and each segment's circumference is measured.

RESULTS: LVA was performed in 70 patients, 22 with primary lymphedema and 48 with secondary lymphedema. The differences in preoperative upper limb volume was 35%, with mean postoperative follow up of 9 months. The mean number of lymphovenous bypasses was 3.9. The reduction in limb volume at 3, 6 and 12 months was 40.4%, 41%, and 45%, respectively. Patients with early-stage lymphedema had significantly higher volume reductions than patients with late-stage lymphedema at 3, 6 and 12 months (48% versus 18%, 49% versus 22%, 65% versus 31%; p < 0.001). For lower extremity lymphedema, the preoperative volume differential was 25.5%. The mean postoperative follow up was 9 months. The reduction in limb volume at 3, 6 and 12 months was 28%, 37% and 39%, respectively.

CONCLUSIONS: Lymphaticovenular anastomosis surgery is a safe and effective method of reducing lymphedema severity, especially in upper extremity lymphedema at an earlier disease stage.