Technical simplification of the supermicrosurgical side-to-end lymphaticovenular anastomosis using the parachute technique.

Abstract

Supermicrosurgical side-to-end (S-E) lymphaticovenular anastomosis (LVA) is the most favorable anastomotic configuration for the treatment of lymphedema because it creates antegrade and retrograde lymph flow while preserves the native lymph flow. However, it is technically demanding and its successful performance has been limited only to the experienced LVA surgeons. This study aimed to evaluate the applicability of parachute technique in S-E LVA and its potential in decreasing the technical complexity of the procedure. Between April 2010 and July 2011, S-E LVAs were performed in 14 patients with bilateral lower limb lymphedema with either the conventional technique or the parachute technique. To exclude interoperator variability of LVAs, only limbs in which S-E LVAs performed by one surgeon were included. Feasibility, anastomotic patency, operative times, and treatment efficacy of both techniques were retrospectively compared. Thirty-seven S-E LVAs were performed by the surgeon; 17 LVAs with parachute technique in seven limbs and 20 LVAs with the conventional technique in seven limbs. Both groups demonstrated 100% anastomotic patency. Time required to perform the S-E anastomosis using the parachute technique was significantly shorter than when the conventional technique was used (8.6 ± 3.7 vs. 11.3 ± 3.1 minutes, P = 0.025). Both groups showed similar postoperative reduction in lymphedema indices (19.9 ± 8.2 vs. 18.9 ± 10.0, P = 0.841). The parachute technique simplifies the supermicrosurgical S-E LVA while maintaining efficacy comparable to the conventional technique.