Lymphedema surgery -
treating lymphedema
Info table on Lymphedema surgery:
- Anaesthesia
Intubation anaesthesia
- OP duration
60 – 150 min
- Hospital stay
3-4 Days
- Socially acceptable
Immediately after OP
Patients with chronic lymphedema – hereditary (primary) or after, for example, tumor surgery (secondary) – are usually marked by significant limitations, recurring infections and, last but not least, cosmetic limitations. Those affected often try to seize every opportunity to improve their illness. In addition to the undisputed conservative therapy with decongestion and compression therapy, lymphatic surgery is becoming increasingly important.
How can lymphedema be treated with lymphedema surgery?
Even the most modern methods of microsurgery are not evaluated uniformly by all sides. Statements ranging from “it can be used to heal patients” to “this should definitely not be done” can be found online. So, what is it all about – what can patients expect and how can you recognize a good facility for such interventions?
When does an intervention make sense?
The modern microsurgical procedures, such as ” lymphovenous anastomoses” or the “free vascularized lymph node transfer” help – if successfully carried out – to address the watery component in the affected body region in particular. The softer the lymphedema is, the more it makes sense to think about such an intervention. If the lymphedema is very advanced and extremely hardened, microsurgical procedures are less effective.
Conservative therapy vs. surgery
Warnings are often given in forums that one should never have an operation in the early stages, and only conservative therapy should be carried out here. However, keeping the progressive damage of the lymphatic system and the increasing hardening of the tissue in mind, it should correctly be said: If conservative treatment have not led to a significant improvement in the findings/resolution of the symptoms after a sufficiently long period of time (6-12 months), an operative microsurgical treatment should be considered.
The longer the patient waits, the less favorable the conditions for surgical therapy with reconstructive procedures. However, this must also be seen individually in individual cases: in some patients, the lymphedema and the damage to the tissue progresses very quickly, in other patients microsurgical therapy can still be successful many years after the onset of the disease.
When is the treatment of lymphedema successful?
Now what does successful mean? In very few cases can patients be “cured”, but in the majority of cases a significant improvement can be brought about and at least the course of the disease can be stopped and the intensity of conservative measures reduced. In individual cases, patients can even end this.
Many patients are afraid that this form of therapy is even harmful in many cases. Of course, this depends not least on the planned procedures, but many innovations have been introduced in the operations in recent years. In the case of lympho-venous anastomoses, the trend is clearly moving weg from multiple anastomoses to nur noch 1-2 anastomoses per extremity. These can be performed by the surgeon with much more concentration in a significantly shorter operation time, the flow on these few anastomoses is higher and thus also reduces the anastomosis closure rate. However, these few anastomoses are usually sufficient for an improvement.
If an occlusion occurs, the patient still has other lymphatic vessels, so that the risk of a worsening of the findings is minimized. In the area of free lymph node transfer, techniques are used today in which with a high degree of certainty only those lymph nodes that are dispensable are removed, whereas the “important” lymph nodes are marked and spared (reverse lymphatic mapping ) can.
When can good results be achieved?
Overall, it must be stated that really good results can almost always only be achieved if the entire interaction between surgical and conservative therapy is perfectly coordinated. In the course of this, the intensity of the conservative therapy can then be reduced if necessary and, in exceptional cases, it can be dispensed with entirely.
If there are no longer sufficient lymph channels and the hardening of the tissue due to protein and fat deposits predominates, liposuction can be the procedure of choice in selected cases and if the technique is used correctly. Here, too, it must be clearly communicated that the conservative therapeutic measures must be continued even after the procedure has been completed.
How does the patient know if he is in a good centre?
- Look for testimonials from other patients
- Ask how many patients the center treats surgically on average.
- What technical equipment is provided?
- Is a fluorescence imaging camera used for preoperative diagnostics and OP planning, does the center have a fluorescence unit integrated in the OP microscope?
- Is there a differentiated post-treatment scheme?
- Does the surgeon work with conservative lymphatic clinics?
- Do the patients receive follow-up care from the treating surgeon for years after the operation?
At the end of the day, it should be clear to you as a patient that a special team within the center is looking after you with a high degree of motivation, a clear plan and the appropriate expertise. If in doubt, a second opinion should always be obtained. It is not uncommon for colleagues from conservative lymphatic clinics to be able to give you good advice, because here the colleagues can assess the operative results of the centers and their patient management.
Our procedures in lymph surgery:
In the area of the affected extremity, individual lymph channels are identified with the help of fluorescence imaging and connected to blood vessels (veins) under the surgical microscope (so-called ” lymphovenous anastomoses”).
Here, the body’s own lymph nodes with blood-supplying vessels are removed and transplanted into the affected body region. Care is taken to ensure that only lymph nodes that are dispensable for the body in the corresponding region are removed.
If hardened tissue predominates in the late stages of lymphedema, the excess hardened tissue can be removed with the help of liposuction.
If, for example, lymph fluid collects or leaks after an operation, microsurgical techniques with the help of fluorescence imaging can help .
Mo. – Fr. 8.30-17.00 Uhr und nach persönlicher Vereinbarung.
(Termine nur nach Vereinbarung.)
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