Where it starts
The decision to undergo surgery for lymphoedema is an important step. Every patient is individual and your decision to proceed with surgery will be made on the basis of your discussion with the surgeons at OLP as to the type of operation that is best suited for you.
Of the three main types of surgery available for lymphoedema – Lymphaticovenular Anastomosis (LVA), Vascularized lymphnode transfer (VLNT) and Liposuction for lymphoedema (SAPL) – it is likely that one of these is most suitable for you. The decision of when to have surgery and whether, in some cases, to be awake or asleep during your operation are factors that are discussed in a bespoke way with your surgeons. We would be happy to arrange for you to be able to discuss this with patients who have previously been in your situation and who have undergone surgery under our care.
Preparation for your operation
Having decided to undergo surgery for lymphoedema, we will send you various information leaflets pertaining to the process of undergoing surgery. These include advice regarding the hospital, financial arrangements, the process of your actual operation and any required after-care. No particular changes are needed in your activity or diet in the run-up to surgery. We advise patients to carry on with their routine conservative management of lymphoedema including compression garments, manual lymphatic drainage and intermittent pneumatic compression as usual.
On the day of your surgery
On the day of your operation you will come to the Manor Nuffield Hospital prior to the scheduled start time of your surgery. Many people travel to Oxford on the day of surgery, sometimes necessitating an early start. Traffic in Oxford can be busy, especially in the morning rush-hour, and account needs to be taken of this. Many patients coming from further afield choose to stay locally the night before and if you wish to do this we will be happy to give advice regarding accommodation options in and around Oxford.
If undergoing surgery under anaesthesia or sedation, you will need to be starved in time for the operation and in that instance you must not eat or drink anything milky, solid or fizzy in the six hours prior to your operation starting. Clear fluids only (still water, squash, black coffee or black tea) can be taken up to 2 hours prior to the start of your operation. For any operation under local anaesthetic only there are no restrictions as to dietary intake in the run up to your operation although it is advisable not to eat or drink heavily immediately beforehand.
On arrival at the hospital you should check in at the front desk and you will then be directed towards either the day surgery unit or the ward. From there the ward staff will complete final hospital paperwork including preparation for theatre. At this point removing your compression garment would be appropriate. No form of particular cleaning or shaving is required prior to surgery; you will be advised regarding the wearing of rings and jewellery at that time. In this period the surgeons (and anaesthetist if your surgery is to be undertaken under anaesthesia or sedation) will discuss the details of your upcoming operation with you and ask you to sign the hospital consent form. This will include all the issues previously discussed with you regarding your surgery
Transfer to the Operating Theatre
You will then be transferred to the operating suite. Prior to your operation starting ICG lymphography and vascular ultrasonography are undertaken to map the lymphatics of your affected limb. If having your LVA surgery under local anaesthetic only, you will be awake during this process and this is often an interesting time for you.
If undergoing surgery under anaesthesia or sedation, you would normally not have recollection of this element of planning.
During your operation
If undergoing surgery awake, you will be an active part of the operation in terms of positioning your limb and orientation of the operating microscopes. Draping of your affected limb to provide a sterile operating field takes place and thereafter it is important that you are able to lie completely still for periods of time while the LVA surgery is undertaken. Typically at “half-time” it is possible for you to wriggle a little prior to the second set of anastomoses being undertaken. Once an LVA operation is complete you are free to move your limb again. If undergoing other surgery under sedation or anaesthesia you will regain full awareness either in theatre or the recovery suite, from where you will be transferred back towards a ward environment. Dressings are applied to the skin incisions; these are typically showerproof. After LVA or LNT surgery showering from the following day is entirely reasonable.
After your operation
Whatever surgery you have had it is advisable to have a restful first week after your operation. Details of wound care, diet and use of compression garments is dependent on which type of surgery you have had; our post-operative care guides for LVA, LNT and Liposuction cover all aspects of your recovery. Briefly, day-case LVA surgery requires gentle activity only in the first week with normal activity to be gradually reintroduced over the following weeks. Any non-absorbable stitches can be removed at approximately two weeks either local to you or back in Oxford. At that stage it would be anticipated that your skin would be healed and watertight although the scars will take some time to mature and settle. Showering can be undertaken the day after your surgery. No changes to your diet are needed. Looser limb compression should be re-established initially at one week and then your full compression is commenced after your sutures are removed approximately two weeks after your operation. Returning to normal activity normally happens fairly quickly after this time.
LNT care depends on where the lymphatic tissue has been harvested from. This surgery requires anaesthesia and usually three nights in hospital. Drains will be removed in the days after surgery and your post-operative diet may be temporarily altered depending on where the lymphatic tissue is taken from. The use of compression garments is similar to that after LVA surgery.
Liposuction also requires anaesthesia and three nights in hospital. Changing the post-operative dressings to formal compression garment is undertaken by us a few days after your operation and adherence to post-operative garment use is a very important part of your post-operative care. In all cases taking it easy in the first week or two is important and returning to a normal level of activity thereafter will be dependent on the type of surgery that you have had.
In the months after your surgery your scars will settle in terms of contour and colour. Wearing of your compression garments during this period is very important and dependent on your response to treatment, you may be advised to alter your garments (sometimes including a decrease in recommended garment usage) by the surgeons in Oxford.
Outcomes of your surgery are assessed at regular intervals with the team in Oxford and include limb volume measurement and quality of life scoring. We routinely see all cases for 12 months and depending on your proximity to Oxford we often continue to see patients in the longer term.
It would be impossible for me to fully explain the difference that the improvement in my Lymphedema has made to my quality of life so far - Thank you!
Please thank Mr Gore who saw me for his very helpful letter, it is good to know that there is somewhere to turn to for clarity on lymphoedema
Without your surgery on my arm I don’t think I could of done this , I climbed Kilimanjaro on New Year’s Day
I think the service you have given me has been the best medical experience I have ever had, the team is very professional but with a really great empathy for the patient which makes one feel very comfortable and cared for.
My left leg is still staying soft and maintaining a good shape. I have noticed a reduction in my thigh area recently just by looking!
The surgery has made a big difference to my mobility, which has enabled me to do things that I want to do. The pain has lessened, which has improved my quality of life. Everyone in the practice I've had contact with has been kind and understanding. They've worked hard to make things better for me.
Many thanks for your wonderful service. You've changed my life by correcting my painful lymphoedema. Coming to see you was the best thing. All my thanks for making such a difference to my and our lives.
Nuffield Health, The Manor Hospital, Beech Road, Oxford, OX3 7RP
Oxford Lymphoedema Practice, PO Box 1138, Oxford, OX1 9UN
© Oxford Lymphoedema Practice Ltd 2018