Net effect of lymphaticovenous anastomosis on volume reduction of peripheral lymphoedema after complex decongestive physiotherapy.

ABSTRACT

OBJECTIVE: The results of reported lymphaticovenous anastomoses include some effects of complex decongestive physiotherapy (CDP). The present study aimed to determine the net effect of lymphaticovenous side-to-end anastomosis (LVSEA) in patients with lower limb lymphoedema treated by preoperative CDP. DESIGN: Retrospective observational study. MATERIALS 37 LVSEAs in 31 patients. METHODS: Volumes of the thigh and leg with oedema were compared between the time of initial examination, and before (application of CDP) and after LVSEA. The patients were divided into two groups based on the number of anastomoses and lymphoscintigraphic findings. RESULTS: Preoperative CDP resulted in a reduction of 593 ml (both leg and thigh; p < 0.001). After CDP, LVSEA (1-8 anastomoses; average of 5) reduced the volume by 109 ml (52 ml for the thigh (p = 0.01) and 57 ml for the leg (p = 0.002)). There was no significant difference in volume reduction on lymphoscintigraphy. Volume was significantly reduced (by 55 ml in the thigh, p = 0.049; 96 ml in the leg, p = 0.006) in the group that underwent 6-8, but not 1-5 LVSEAs. CONCLUSIONS: The net effect of LVSEA on volume reduction was confirmed, but was not particularly large. The need for CDP decreased in some patients postoperatively, and these patients should be considered for evaluation.