Proximal ligation after the side-to-end anastomosis recovery technique for lymphaticovenous anastomosis

Abstract

Background Lymphaticovenous anastomosis is an important surgical treatment for lymphedema, with lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous endto-end anastomosis being the most frequently performed procedures. However, LVSEA can cause lymphatic flow obstruction because of regurgitation and tension in the anastomosis. In this study, we introduce a novel and simple procedure to overcome this problem. Methods Thirty-five female patients with lower extremity lymphedema who underwent lymphaticovenous anastomosis at our hospital were included in this study. Eighty-five LVSEA procedures were performed, of which 12 resulted in insufficient venous blood flow. For these 12 anastomoses, the proximal lymphatic vessel underwent clipping after the anastomotic procedure and the venous inflow was monitored. Subsequently, the proximal ligation after side-to-end anastomosis recovery (PLASTER) technique, which involves ligating the proximal side of the lymphatic vessel, was applied. A postoperative evaluation was performed using indocyanine green 6 months after surgery. Results Despite the clipping procedure, three of the 12 anastomoses still showed poor venous inflow. Therefore, it was not possible to apply the PLASTER technique in those cases. Among the nine remaining anastomoses in which the PLASTER technique was applied, three (33%) were patent. Conclusions Our findings show that achieving patent anastomosis is challenging when postoperative venous inflow is poor. We achieved good results by performing proximal ligation after LVSEA. Thus, the PLASTER technique is a particularly useful recovery technique when LVSEA does not result in good runoff .

Persistent retrograde venous-lymphatic reflux in side-to-end lymphaticovenous anastomosis in a lower extremity with lymphedema: a case report

“…This result suggested that the retrograde shunt may not be corrected after the surgery. Intraoperative conversion of the STE to ETE anastomosis by ligation of proximal lymphatic vessel was reported in previous studies for management of retrograde venous-lymphatic flow in STE anastomosis in LVA [7,8]. Retrograde venous flow is found relatively frequently in patients with lymphedema.…”

Comparative analysis between Side-to-end and End-to-end LVA for secondary lower limb lymphedema

“…There are few case reports describing the application of side-to-end lymphaticovenous anastomoses and the advantages such as overcoming the size discrepancy. [16][17][18] Yamamoto et al and AlJindan et al reported comparative analysis showing that side-to-end lymphaticovenous anastomosis may have better results compared to endto-end lymphaticovenous anastomosis, but most of the findings were limited to early-stage lymphedema and failed to further explore the difference in outcome for different International Society of Lymphology stages. 17,19 Considering that the valvular dysfunction worsens as the lymphedema progresses, a comparative analysis is warranted between the different International Society of Lymphology stages of lymphedema patients.…”