The Use of Lympho-Venous Anastomoses to Prevent Complications from Ilio-Inguinal Dissection

Abstract

Lympho-venous anastomoses (LVA) were performed in 30 patients, immediately after the completion of ilio-inguinal dissection for metastatic nodal involvement. This surgical procedure, originally devised to treat post-mastectomy lymphedema from radical mastectomy, was intended in this series of cases to prevent complications from ilio-inguinal nodal dissection. Actually, when compared to another group of 84 patients previously operated on by ilio-inguinal nodal dissection without lympho-venous anastomoses, the series showed a lower rate of local-regional complications (38% vs 65.9%). The mean duration of hospital stay was also reduced (18.5 vs 34.7 days). Distant lymphedema of the lower limb was observed in 7 of 23 patients who had received LVA, whereas in the control group, lymphedema was recorded in 39 of 52 patients who were regularly followed-up (30% vs 75%). LVA should be routinely used, as a useful surgical procedure, to prevent or reduce the occurrence of local-regional complications following ilio-inguinal nodal dissections.

Minimally invasive multiple lymphaticovenular anastomosis at the ankle for the prevention of lower leg lymphedema

“…Several authors have reported the use of preventative measures for patients with lymphatic edema who do not present with symptoms . Orefice et al reported that LVA was a useful surgical procedure for preventing or reducing the occurrence of local‐regional complications following ilioinguinal nodal dissection.…”

“…Several authors have reported the use of preventative measures for patients with lymphatic edema who do not present with symptoms. 15,16 Orefice et al reported that LVA was a useful surgical procedure for preventing or reducing the occurrence of local-regional complications following ilioinguinal nodal dissection. In addition, Campisi et al reported that diagnostic and therapeutic preventive procedures reduce the incidence of secondary lymphedema of the upper limb.…”

Microsurgical Strategies for Prophylaxis of Cancer-Related Extremity Lymphedema: A Comprehensive Review of the Literature

“…The array of surgical interventions for prophylaxis of LEL is more diverse compared with UEL and varies also on the lymphadenectomy site since prevention of LEL may be considered after paraaortic, ilio-inguinal, or ILND; ►Table 2). 29,39,40,42,43,52,53…”

“…In 1998, Orefice et al first reported the use of primary isotopic telescopic LVAs after ilio-inguinal lymphadenectomy. 52 A grooved needle was used for lateral implantation of one or more lymphatics into a large recipient vein. The authors described a LE rate of 30% (7/23), compared with an incidence of 75% (39/52) in the control group.…”

“…15 Additionally, none of the published studies has compared the efficacy of prophylactic surgery with prophylactic CDT, which is considered the mainstay of conservative management for established LE. Although four of the studies in this review included control groups for comparison, two studies for UEL 38,50 and two for LEL, 39,52 patients in those control groups did not receive any treatment at all. To the best of our knowledge, comparative studies between prophylactic CDT and prophylactic surgery for prevention of LE are still lacking.…”