Before reading about the different surgical treatment options, we recommend reading about the lymphatic system, and what goes wrong in lymphoedema.
In the early stages of lymphoedema, fluid builds up in the affected arm or leg because it can’t get back to the bloodstream. LVA surgery directly connects the lymphatics in the arm or leg to the veins. This means that the fluid has a direct route back into the bloodstream. It is like a bypass being built around a congested section of road – it keeps the traffic flowing.
This operation is highly technical, and needs specialist training. We use a technique called supermicrosurgery, where stitches thinner than a human hair are used to join tiny tubes less than a millimetre in diameter. We have all trained extensively in this surgery, including with the pioneers of LVA in Japan. At Oxford Lymphoedema Practice, we always operate with two surgeons at the same time, in order to minimise the operation time, and ensure the maximum number of LVA joins can be made.
The operation is minimally invasive. We perform it under local anaesthetic, where you stay awake during the operation. This allows you to make a fast recovery, and go home the same day. Most patients have two weeks off work, after which the stitches are removed, and most normal daily activities can be performed.
We transplant some healthy lymph nodes from either inside the abdomen or the base of the neck to the area with swelling. The transplanted lymph nodes can then help to repair the damaged lymphatics and drain the fluid. LNT can also be combined with LVA surgery in order to optimise your reconstruction and recovery.
We typically do not take lymph nodes from the armpit or groin because of the potential risk of inducing lymphoedema in the limb near that site.
Liposuction for lymphoedema
When lymphoedema has been present for a while, the proteins and cells in the fluid cause the build-up of fat in the arm or leg. This is not because you are putting on weight, it is a direct result of the lymphoedema fluid. When fat as well as fluid has built up in the arm or leg, the only way to correct this part of the swelling is to directly remove it by liposuction.
Liposuction for lymphoedema also requires specialist training, and all of our surgeons have spent time with the pioneer of this surgery in Sweden. Importantly, it should not be confused with cosmetic liposuction – it is very different.
This operation is more invasive than LVA, and requires a general anaesthetic where you are asleep for the procedure. Most patients stay in hospital for around three days afterwards. We make a number of tiny incisions on your arm or leg, and use a suction device to remove the fat from under the skin. Most people have around four to six weeks off work, but most daily activities can be performed much sooner.
Because the fluid part of lymphoedema is not corrected by this procedure, you need to wear compression garments afterwards, or undertake one of our other procedures at a later date to help with management of excess lymphatic fluid.
It would be impossible for me to fully explain the difference that the improvement in my Lymphoedema 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
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.