Lifechanging surgery offers new hope
Lymphoedema causes painful swelling of the body’s tissues and treatments for the condition are limited. But Spire Cardiff Hospital says its intricate “super micro-surgery”is offering new hope to patients
Patients are being offered the latest in “super micro-surgery” to tackle a condition that can cause extremely swollen limbs, poor mobility and the risk of regular infections.
Lymphoedema is caused by damage or disruption to the lymphatic system which drains excess fluid from the body tissues through a complex network of channels, glands and nodes.
Although it can affect any part of the body it usually develops in the arms or legs.
It is thought to affect more than 200,000 people in the UK, with many of the sufferers developing the condition following various cancers – predominately breast.
But despite the number of patients with the condition, treatment options until recently have been fairly limited.
Compression garments are often used in an effort to keep swelling under control – in most cases for the rest of their lives.
In addition, lymph nodes transfers – moving healthy nodes into areas where the drainage system has “broken down” – has in the past few years become one option of tackling the illness successfully.
However a new form of “supermicro surgery” called lymphovenos anastomosis (LVA) means surgeons can join miniscule lymph vessels to veins which will then help drain the excess fluid that builds up rather than allowing it to gather in the body.
Plastic reconstructive surgeon Amar Ghattaura, who is now leading the lymphoedema team at Spire Cardiff Hospital in Pontprennau, explained: “Put simply it is all about getting the body’s plumbing working properly.
“We are just diverting a blocked flow to where there is a good flow. Bypass the blockage and the drainage system will begin to function properly again.”
However, Mr Ghattaura’s “simple” explanation masks the complicated surgery that, at the moment, only he can carry out super micro-surgery in the whole of Wales.
Pioneered in Japan, and developed further in European medical centres such as the Barcelona breast cancer unit, LVA surgery involves joining lymphatic tubes to veins.
But whereas the blood vessels may be 2mm to 3mm in diameter, lymph vessels are 10 times smaller at just 0.2mm to 0.3mm sometimes as thin as a human hair.
The process involves the injection of a highly fluorescent dye into the patient. Then, by using an infrared camera, the surgeon receives a dynamic image of the lymphatic vessels and nodes and can also check which channels are functioning properly.
“This basically gives us a road map to the body’s lymphatic system – something that helps in both LVA and Lymph Node Transfer (LNT). It makes it much easier for us to select the lymphatic tubes or veins.”
The lymph vessels we attach are about 0.3mm in diameter and we must use a microscope to reattach them as they can barely be seen with the naked eye. It is fair to say that such surgery requires a steady hand to say the least,” explained Mr Ghattaura.
The operation, carried out through a small incision in the effected limb, also means that most patients will be able to leave hospital on the same day and, instead of having to wear compression bandages, will wear soft bandages for two weeks until their return to surgery for check-ups and stitches removal.
Mr Ghattaura said the benefits of the new service would be “enormous”.
“Curing lymphoedema would be life-changing for many patients. It would really improve their quality of life.
“Patients who now need compression garments will either not need them at all or need them far less. For these patients, this is a cure.
“In Japan and parts of Europe, the super-microsurgery procedure has seen up to 96% of patients have reduced cellulitis episodes while up to 70% have been able to stop using compression garments.
“There will also be less infection, if any, so they will not have to keep going to their GP for antibiotics and there will also be a reduced risk of skin problems like ulceration.”
In some cases the LVA procedure isn’t right for a particular patient, but Spire Cardiff’s lymphoedema team also has the expertise to perform Lymph Node Transfer surgery as well as to offer liposuction as another surgical treatment option.
“By putting the right team together we are able to offer the complete package to lymphoedema sufferers from consultation to selected surgery and then aftercare.
“Besides the obvious pain and discomfort caused by the condition, it can also lead to anxiety and depression.
“People have been looking for a cure for years – with this super micro-surgery procedure I think we are offering something that could change the lives of thousands of people for the better,” said Mr Ghattaura.