Lymphatic Reconstructive Surgery in Primary and Secondary Lymphedema: A Comparative Outcome Study.

[INTRODUCTION] Primary lymphedema (PLE) presumably results from an abnormal development of the lymphatic system. Current PLE management strategies are mainly rooted on practice algorithms well established for secondary lymphedema (SLE). The effectiveness of lymphovenous anastomosis (LVA) in PLE is an ongoing debate.

[METHODS] Patients recorded in the University Hospital Zurich database with PLE or SLE who underwent LVA and/or vascularized lymph node transfer (VLNT) between 2016 and 2023 were analyzed. Limb volumes were evaluated preoperatively and at specific postoperative time points, comparing outcomes after different surgical procedures and their combination.

[RESULTS] Fourty-eight limbs met the inclusion criteria for this study. In PLE patients, LVA alone showed significantly less effective results in the change of limb volume than VLNT alone (P = 0.035). LVA only reduced limb volume in 25% of treated patients, whereas VLNT only or VLNT in combination with LVA reduced limb volumes in 70% and 54.5% of treated patients. Concerning patients experiencing an actual reduction in limb volume, LVA alone lead to a limb volume reduction of 3.46% in PLE patients and 3.72% in SLE patients, whereas VLNT alone showed a median reduction of 5.36% and 7.98% in PLE and SLE patients, respectively.

[CONCLUSIONS] Executing LVA alone seems to be less effective than executingVLNT alone. Consequently, in PLE patients we encourage to execute VLNT primarily, along with intraoperative Indocyanine-green-angiography-guided decision-making regarding the implementation of additional LVA.