There’s a lot of actual information on surgical lymphedema treatment that lies beyond the reach of the average patient due to the language barrier and hence an unawareness of where to get it from. Publications in Russian are scarce. There are speculations that lymphovenous anastomosis is an outdated procedure, developed in the 1960s and it is not used today because of its proven inefficiency.
In the USSR surgery of the lymphatic system was a progressive field but with abilities that equipment of those days could provide. Microscopes were not that good, supermicrosurgical tools were not available, suturing threads were poorer, and so were anastomoses. To be more illustrative, compare an iPhone with a pay phone.
The most discussed myths about lymphovenous anastomosis are “thrombosis of a anastomosis”, “with osmosis blood from a vein would spread into lymph”, and “lymph mixes with venous blood with no filtration”. However, there’s an opposite situation observed in surgery worldwide. Lymphovenous anastomosis is made all over Europe, the USA, and the Pacific. The number of papers regarding it has grown dramatically. There were tens of thousands by the end of 2010.
Our goal is to disclose these myths and to provide you with scientific facts in a growing and developing direction.
An interesting paper was published by a group of surgeons from the USA and France in 2021 where the size of the limb in patients with postmastectomy lymphedema of I and II stages was assessed. It showed that even in long-lasting cases with even 7-year lymphedema lymphovenous anastomoses can significantly improve the condition. In this paper, a reduction in the size of a limb to 100% was shown. The best results were in a group with an early stage of disease, with the follow-up up to 8 years the results were optimal.
Another research, a metanalysis made by Swiss scientists (Mario F Scaglioni, Duveken B Y Fontein , Michael Arvanitakis , Pietro Giovanol ) included 18 papers with 938 patients included in total with maximum follow-up of 29 years! Authors had shown that one of the important factors of effectiveness is a surgical technique, as well as the performance of additional procedures like vibroliposuction with fibrosis excision and compression therapy post-op 75% of patients who had undergone lymphovenous anastomosis, had good results and the rate of infections was lowered in all cases.
The long-lasting effect of lymphovenous anastomosis was also shown in Joost Wolfs, Luuke de Joode, René R van der Hulst, and Shan S Qiu paper. In it, 25 patients had indocyanine green lymphography before surgery. They underwent it again 12 months after lymphovenous anastomosis. In 72% of patients, anastomosis was adequate. This proves that a year-old anastomosis can still drain lymph which proves the efficiency of lymphovenous anastomosis.
Before surgery, 80% of patients had to wear compression garments. Year after lymphovenous anastomosis 65% of them ceased wearing any garments and 10% wore it occasionally. 84% of patients had to have a lymph drainage massage, after the procedure 74% continued and 24 ceased, which shows a quality-of-life increase.
Conclusion
From the literature review, it is seen that lymphovenous anastomosis is a highly effective, performed procedure with ongoing research. We can observe the regression of the swelling almost to none and anastomoses are functioning in a year after the procedure. It also prevents infections like erysipelas. This procedure is as safe as it can be but important steps should be made to provide it – scrutiny in pre-operational diagnostics, performance in early stages of disease, and masterly performed suturing. If those conditions are abided the result of the procedure will be marvelous.
A paper by Ivashkov V. Yu. And Arutyunov I. G.