Supramicrosurgical lymphatico-venular anastomosis (LVA) in treating lymphoedema: 36-months preliminary report

OBJECTIVE: Lymphoedema of the extremities is a widespread pathological condition that mostly occurs as a complication of cancer resections, especially in women. Conventional therapy refers to conservative and physiotherapeutic approaches. Surgical strategies have been widely reported in the literature and are still challenging. Part of this literature focuses on the supra microsurgical lymphaticovenular anastomosis (LVA) technique. LVA is characterized by a high success rate, minimal invasivity and broad indications. Furthermore, this procedure can be performed under local anesthesia. PATIENTS AND METHODS: From October 2011 through October 2014, 69 patients affected by lymphedema underwent LVA surgery in Siena University Hospital, Italy. Preoperative and postoperative evaluations were taken. RESULTS: Totally, 366 anastomosis have been performed. The average rate was 5.3 anastomosis per patient. All patients registered a decrease in the size of the affected side. The average volume reduction was 50%. Patients also showed a reduction of lymphangitis episodes and reduction of compression garments class. Moreover, a satisfaction index was evaluated. The majority of patients (72.5%) was extremely satisfied of the surgery. CONCLUSIONS: LVA has demonstrated to be an effective surgical strategy to treat lymphoedema, especially in secondary cases in early stages. Although LVA is widely discussed in the literature, the majority of works relates to Japanese authors and few reports exist outside Japan. This paper represents the very first retrospective analysis of the adoption of LVA technique in Italy and one of the few outside Japan.