Lympho-nodo-venous Shunt for Filarial Lymphoedema
Background:Treatment for lymphoedema is a lifelong process. Conservative treatments often fail, and no surgical procedures offer complete cure. Several patients reported in miserable condition seeking help for heaviness of limb, discharge, disfigurement, lymphangitis, elephantiasis, and restricted mobility. Hence, we decided to undertake this prospective study of lymphonodovenous shunt (LNVS) for various stages of lymphoedema.
Methods: Thirty–one patients underwent LNVS in three years duration study. Six patients underwent debulking surgery a week later. Nine patients underwent bilateral procedure.
Results: More than 50% reduction in oedema occurred in 24/31 (77.41%) patients within first five days. Three of six patients with Grade IV lymphoedema who had undergone debulking surgery and skin grafting at follow–up showed hypertrophic scarring, ulceration and exophytic keratosis at split skin grafting (SSG) area.
Conclusion: LNVS is a procedure not free from complications like infection and hematoma. Yet the procedure was found to be safe, simple, and easy. It also helped to reduce the incidences of postoperative lymphangitis attacks. We recommend the procedure for Grade II–III lymphoedema and for Grade IV lymphoedema in combination with debulking surgery.
2. Leo Clodius : Lymphoedema. In Plastic Surgery. (Ed.) Joseph G. McCarthy, Vol. 6. W.B. Saunders Company, Philadelphia (U.S.A.), 1990, pp 4093–4126.
3. World Health Organisation. Evaluation of morbidity in lymphatic filariasis 1992.WHO/TDR/FIL/MA/92.3 https://apps.who.int/iris/bitstream/handle/10665/61099/TDR_FIL_MAD_92.3.pdf;jsessionid=04EE2AFDC3E1DBCC9943142E8A67BA88?sequence=1
4. Y Govardhan Rao, N Ananthakrishnan, SP Pani, V Kate, J Yuvaraj, K Krishnamoorthy: Factors influencing response to lymphonodovenous shunt in filarial lymphoedema. Nat Med J India 1999; 12 : 55–58. http://archive.nmji.in/archives/Volume-12/issue-2/original-articles-2.pdf
5. Zelikovski A, Haddad M, Reiss R : Nonoperative therapy combined with limited surgery in the management of peripheral lymphoedema. Lymphology 1986; 19: 106–108. https://pubmed.ncbi.nlm.nih.gov/3784614/
6. Binoy C, Rao YG, Ananthakrishnan N, Kate V, Yuvaraj J, Pani SP : Omentoplasty in the management of filarial lymphoedema. Roy Soc Tropi Med Hyg 1998; 92 : 317–319. https://pubmed.ncbi.nlm.nih.gov/9861407/
7. Dandapat MC, Mukherjee LM, Patra SK : Evaluation of different surgical procedures in filarial lymphoedema of lower extremity. J of Ind Med Asso 1991; 89 : 127–129. http://europepmc.org/article/MED/1748777
8. Jamal S : Lymphovenous anastomosis in filarial lymphoedema. Lymphology 1981; 14 : 64–68. https://pubmed.ncbi.nlm.nih.gov/7289664/
9. Pranav R Patel, Prerak Patel, Pankaj Modi . A Prospective Study of Nodovenous Shunt . Surgery in Lymphoedema . Medpulse International Journal of Surgery (MIJOSUR) 2018; 5 (1) : 23-25
10. Degni M : Surgical management of selected patients with lymphoedema of the extremities. J Cardiovascular Surg 1984; 25: 481–488. https://pubmed.ncbi.nlm.nih.gov/6392306/
11. Dhandapat MC, Mohanpatro SK : Filarial lymphoedema and elephantiasis of lower limbs. Br J Surg 1986; 73:451–453. https://pubmed.ncbi.nlm.nih.gov/3719269/
12. Karmazanovskii GG, Savchenko TV : Assessment of the results of surgical treatment of lymphoedema based on computerized tomography. Khirugiia 1996; 2 : 71–73. https://pubmed.ncbi.nlm.nih.gov/8754908/
13. Gloviczi P: Principles of surgical treatment of chronic lymphoedema. International Angiology 1999; 18: 42–46. https://pubmed.ncbi.nlm.nih.gov/10392479/
Copyright (c) 2021 Jayant D Mohite, Yatindra Kashid
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.