What is Involved in Lymphedema Surgery?

Lymphedema is a medical condition in which a collection of lymph fluid causes swelling in the extremities, usually as the result of some types of surgery or after an injury to the lymph nodes. During a lymphedema attack, the flow of lymph through the channels becomes blocked, resulting in pressure and swelling as the fluid backs up. The two main categories of lymphedema surgery are lymphatic reconstruction surgery and excision. They are designed to redirect or remove the collection of lymph fluid to promote a reduction in limb swelling and increase patient comfort, but neither method offers a cure and other treatments will remain necessary. While the procedures' recovery times are fairly short, lymphedema surgery isn't as common in the United States as it is elsewhere, in part because of the risk-to-results ratio.

During lymphaticovenular bypass, one form of lymphatic reconstruction, a physician creates a connection between the lymph channel and the bloodstream. This bridge allows lymph fluids to drain into the bloodstream and helps to prevent the pooling of fluid in the lymph channel that causes the swelling. The bridge between the lymph channels and the bloodstream lets the lymph fluid move to a less congested area, allowing a release of some of the pressure that builds in the affected limb as the lymph fluid collects.

Bypass lymphedema surgery involves making small incisions of around 1 inch (2.54 cm) in the affected area. A doctor works through each incision using special tools designed to create the tiny links between lymph channels and blood vessels. Patients are often released from the hospital within 24 hours following this surgery.

Microsurgical anastomosis is similar to lymphaticovenular bypass in that it also aims to create a new path for the lymph fluid. The difference is that anastomosis connects good parts of different, damaged lymph channels to form one good outlet for the fluid. The concern with this type of procedure is whether the connection will succeed.

Excisional surgery usually involves the removal of excess tissue in the affected limb. This can be accomplished in various ways, including the use of a traditional scalpel or a laser. Lymphedema surgery may also involve placing a stent in the arteries near the lymph nodes. This helps to increase overall circulation to the affected area by opening up the blood vessels. Lymph channels eventually drain into the bloodstream, so improved blood circulation can help to carry excess lymph fluid away from the site of swelling and into the body’s circulatory system.

Surgery for lymphedema does not cure the problem. It is only meant to help reduce some symptoms as part of ongoing therapy. It is often given as an option for patients who have lymphedema that has not responded well to other conventional therapies. Other lymphedema treatments, such as use of compression stockings, massage, and skin care, are used in conjunction with surgery for the best possible results.

Although it is often considered a minimally invasive procedure, lymphedema surgery still carries some risks. The lymph fluid consists of extracellular fluid that carries the waste products of cells, as well as protein and some toxins found in the body. These waste products can spill back into the bloodstream, potentially causing infection and carrying toxins to other parts of the body via circulation. Excisional surgery has its own risks, including the possibility of tissue damage and other complications that could make the lymphedema worse or result in additional problems.