Lymphatic-venous anastomosis for the treatment of refractory lymphatic ascites following radiation therapy: A case report.

Radical treatments for intra-abdominal malignancies disturb physiological lymphatic drainage and predispose the patients to lymphatic complications such as lymphatic ascites. Despite its infrequent occurrence, lymphatic ascites is a morbid complication, and a definitive treatment protocol for refractory cases has not been established. Surgical treatments are opted depending on the etiology, symptoms, and facility equipment. Lymphatic-venous anastomosis (LVA) bypasses the proximal lymphatic blockages and provides an alternative route for lymphatic fluid recirculation into the venous system, thereby improving the lymphatic congestion. Herein, we report the utility of LVA surgery in the treatment of refractory serous lymphatic ascites that developed after radiation therapy for cervical cancer in a 77-year-old woman. The patient had massive ascites and suffered from abdominal distention and anorexia for 1 year. The ascites was unresponsive to conservative treatment. Under local anesthesia, eight incisions were made in the lower extremities just above the lymphatic channels that were identified by indocyanine green lymphography, and a total of 14 LVAs were created. The postoperative course was uneventful, and the ascites improved significantly. The patient remained free from the recurrence of ascites during 3.5 years of postoperative follow-up. LVA surgery was effective for the improvement and long-term control of lymphatic ascites. This procedure may be a viable option for the management of lymphatic ascites.

Local anesthesia for lymphaticovenular anastomosis.

Lymphaticovenular anastomosis is well documented for its effectiveness in treating lower limb lymphedema. However, local anesthesia (LA) is not the usual choice of anesthesia. In this study, 14 patients having such operation done under LA were recruited to see how well they tolerated the operations. Visual analogue scale was used to grade both intraoperative and postoperative pain. It was shown that the mean intraoperative pain score was never greater than 1, in the scale from 0 to 10. The mean postoperative pain score was 1.6 on the first postoperative day and then dropped gradually. No complication of surgery was reported. In-depth preoperative counseling and complementary intraoperative measures were emphasized to make LA a possible choice of anesthesia.

Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to manual lymph drainage: a case report.

Conservative and surgical treatment for lymphedema are performed independently, and combined treatment with lymphatico-venous anastomosis (LVA) followed by manual massage is increasingly reported. However, a problem with this approach is that manual massage cannot be initiated immediately after LVA because of concerns of injuring surgical wounds and anastomosed regions. To overcome this problem, we developed a treatment method using a cosmetic roller instead of manual massage, which allows lymph drainage to be initiated immediately after surgery. In this study, we treated a patient with bilateral lower limb lymphedema using this method. Conventional manual massage starting 3 weeks after surgery was used for the left lower limb, while early massage using a cosmetic roller was used for the right lower limb from the day after surgery. A higher therapeutic effect was obtained in the right lower limb compared to that in the left lower limb. The results in this case suggest that further studies should be performed to examine the new method in various types of patients.

Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-neck cancer.

Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can improve lymph circulation by the anastomosis of lymph vessels and veins. A therapeutic effect of LVA for lymphoedema has been shown in limbs, but efficacy for other regions has not been shown. Lymphoedema in the head-and-neck region following cancer resection and radiotherapy is mainly treated with manual lymphatic drainage. However, there is no alternative when this treatment is ineffective because application of compression treatment using a bandage is difficult in this region. We used LVA for lymphoedema in the head-and-neck region and achieved a good outcome. Functional and dilating lymph vessels were identified using pre- and intra-operative fluorescent lymphography, and a lymph vessel with a diameter of about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The outcome of this case suggests that LVA is applicable for treatment of lymphoedema in the head-and-neck region.