A randomised controlled multicentre investigator-blinded clinical trial comparing efficacy and safety of surgery versus complex physical decongestive therapy for lipedema (LIPLEG)

Maurizio Podda,Marouan Zarrouk,Reinhild Prinz-Langenohl,Daria Kraus,Oliver A Cornely,Maximilian Kovacs,Rebecca Roth,Martin Hellmich

doi:10.1186/s13063-021-05727-2

Abstract

BackgroundLipedema is a chronic disorder of the adipose tissue that affects mainly women, characterised by symmetrical, excessive fatty tissue on the legs and pain. Standard conservative treatment is long-term comprehensive decongestive therapy (CDT) to alleviate lipedema-related pain and to improve psychosocial well-being, mobility and physical activity. Patients may benefit from surgical removal of abnormally propagated adipose tissue by liposuction. The LIPLEG trial evaluates the efficacy and safety of liposuction compared to standard CDT.Methods/designLIPLEG is a randomised controlled multicentre investigator-blinded trial. Women with lipedema (n=405) without previous liposuction will be allocated 2:1 to liposuction or CDT. The primary outcome of the trial is leg pain reduction by ≥2 points on a visual analogue scale ranging 0–10 at 12 months on CDT or post-completion of liposuction. Secondary outcomes include changes in leg pain severity, health-related quality of life, depression tendency, haematoma tendency, prevalence of oedema, modification physical therapy scope, body fat percentage, leg circumference and movement restriction.The primary analysis bases on intention-to-treat. Success proportions are compared using the Mantel-Haenszel test stratified by lipedema stage at a 5% two-sided significance level. If this test is statistically significant, the equality of the response proportions in the separate strata is evaluated by Fisher’s exact test in a hierarchical test strategy.DiscussionLIPLEG assesses whether surgical treatment of lipedema is safe and effective to reduce pain and other lipedema-related health issues. The findings of this trial have the potential to change the standard of care in lipedema.Trial registrationClinicalTrials.gov NCT04272827. Registered on February 14, 2020.Trial statusProtocol version is 02_0, December 17, 2019

Highlights

Lipedema was first described in 1940 by Allen and Hines [1] and has a registered diagnosis in the International Classification of Diseases [2] (ICD-10_GM Version 2020) coded stage- (ICD10-E88.20, E88.21, E88.22, and E88.28)
LIPLEG assesses whether surgical treatment of lipedema is safe and effective to reduce pain and other lipedema-related health issues
The findings of this trial have the potential to change the standard of care in lipedema

Summary

Introduction

Background Lipedema was first described in 1940 by Allen and Hines [1] and has a registered diagnosis in the International Classification of Diseases [2] (ICD-10_GM Version 2020) coded stage- (ICD10-E88.20, E88.21, E88.22, and E88.28). This disease, almost exclusively affecting females, is characterised by a symmetrical bilateral increase of the adipose tissue in the upper and/or lower extremities. Standard conservative treatment is long-term comprehensive decongestive therapy (CDT) to alleviate lipedema-related pain and to improve psychosocial wellbeing, mobility and physical activity. The LIPLEG trial evaluates the efficacy and safety of liposuction compared to standard CDT

Objectives

Methods

Findings

Conclusion