Operative Lymphologie. Therapieoption bei Lymphödem und Lipohyperplasia dolorosa

The typical therapy in lymphology is conservative. However, reconstructive and resective treatments for primary and secondary lymphoedema as well as resective procedures for lipohyperplasia dolorosa (LiDo) "lipedema"have been available for several decades. Each of these procedures has its clear indication and decades of successful history. These therapies represent a paradigm shift in lymphology. In reconstruction, the basic idea is to restore lymph flow, to bypass the obstacle to drainage in the vascular system. The combination procedures of two-stage application of resection and reconstruction in lymphoedema are just as much a "work in progress" as the concept of prophylactic lymphatic venous anastomosis (LVA).In the case of resective procedures, the focus is not only on improving the silhouette, but also on reducing the complex decongestion therapy (CDT) and -in the case of LiDo -freedom from pain by improving imaging procedures and the early use of surgical therapy options, the development of higher stages of lymphoedema should be a thing of the past. For LiDo, the application of surgical procedures avoids lifelong CDT and achieves painlessness. All surgical procedures, but especially the resection procedures, are now possible in a way that is gentle on the lymphatic vessels and should be offered to patients with lymphoedema or lipohyperplasia dolorosa without reservation if the goals -reduction in circumference, avoidance of lifelong CDT and, in the case of LiDo, painlessness -cannot be achieved by other means.

Section: Cornely Method: Wet Technique For Lymphedemamentioning

confidence: 99%

Section: Why Are Surgical Treatments Needed?mentioning

confidence: 99%

“…50 Thus, the substantial coincidence of lipohyperplasia dolorosa and obesity does not come as a surprise. 3,51…”

Section: Obesitymentioning

confidence: 99%

Section: Lymphological Liposculpture For Lymphedemamentioning

confidence: 99%

Section: Secondary Lymphedema After Breast Cancer or Gynecological Tu...mentioning

confidence: 99%

See 3 more Smart Citations

Surgical lymphology. Therapy option for lymphoedema and lipohyperplasia dolorosa

Cornely¹

2023

Body mass index vs. waist‐to‐height‐ratio in patients with lipohyperplasia dolorosa (vulgo lipedema)

Brenner,

Forner‐Cordero,

Faerber

et al. 2023

SummaryBackgroundLipedema, also known as lipohyperplasia dolorosa (LiDo), is a painful condition affecting women, causing a disproportionate accumulation of subcutaneous adipose tissue in the extremities. It carries a lower risk of diabetes and cardio‐metabolic dysfunctions compared to obesity, but coincident obesity can complicate diagnosis and treatment.Patients and MethodsThis retrospective study included 607 female LiDo patients, ≥ 18 years, stage 1–3, from Germany, the UK, and Spain. Data were collected as part of the standard initial assessment for LiDo patients.ResultsBased on waist‐to‐height‐ratio (WHtR), 15.2% of patients were underweight, 45.5% normal weight, 22.1% overweight and 17.3% obese. There was a significant association between WHtR category and age group. Body mass index (BMI) is often overestimated, leading to misdiagnosis of obesity.ConclusionsThe use of BMI also affects the recent decision of the German Federal Joint Committee on the reimbursement of liposuction costs by health insurance funds. Patients with BMI of more than 40 kg/m2 are excluded from cost coverage, and those with BMI between 35 kg/m2 and 40 kg/m2 must first receive conservative obesity therapy. In conclusion, the sole use of BMI in lipedema is unreliable and, in contrast to WHtR, leads to inaccurate diagnoses overestimating overweight and obesity.

Body‐Mass‐Index vs. Taille‐zu‐Größe‐Verhältnis bei Patientinnen mit Lipohyperplasia dolorosa (vulgo Lipödem)

Brenner,

Forner‐Cordero,

Faerber

et al. 2023

ZusammenfassungHintergrundDas Lipödem, auch Lipohyperplasia dolorosa (LiDo) genannt, ist eine schmerzhafte Erkrankung von Frauen, die zu einer unverhältnismäßigen Ansammlung von subkutanem Fettgewebe in den Extremitäten führt. Das Risiko für Diabetes und kardiometabolische Störungen ist im Vergleich zur Adipositas geringer, doch kann eine gleichzeitige Adipositas die Diagnose und Behandlung erschweren.Patientinnen und MethodikDiese retrospektive Studie umfasste 607 LiDo‐Patientinnen, ≥ 18 Jahre, Stadium 1–3, aus Deutschland, dem Vereinigten Königreich und Spanien. Die Daten wurden im Rahmen der Standard‐Erstuntersuchung erhoben.ErgebnisseBasierend auf dem Verhältnis von Taillenumfang zu Körpergröße (Waist‐to‐Height‐Ratio; WHtR) waren 15,2% der Patientinnen untergewichtig, 45,5% normalgewichtig, 22,1% übergewichtig und 17,3% adipös. Es bestand ein signifikanter Zusammenhang zwischen der WHtR‐Kategorie und der Altersgruppe. Der Body‐Mass‐Index (BMI) wird häufig überschätzt, was zu Fehldiagnosen von Fettleibigkeit führt.SchlussfolgerungenDie Verwendung des BMI hat auch Auswirkungen auf die jüngste Entscheidung des Gemeinsamen Bundesausschusses über die Kostenerstattung von Fettabsaugungen durch die Krankenkassen. Patientinnen mit einem BMI von über 40 kg/m2 sind von der Kostenübernahme ausgeschlossen, und Patientinnen mit einem BMI zwischen 35 kg/m2 und 40 kg/m2 müssen zunächst eine konservative Adipositastherapie erhalten. Die alleinige Verwendung des BMI bei Lipödemen ist unzuverlässig und führt im Gegensatz zum WHtR zu ungenauen Diagnosen, die Übergewicht und Adipositas überbewerten.