Tumescent liposuction for lipoedema: A systematic review of clinical effectiveness and safety

Abstract

Abstract Background Tumescent liposuction is an established method for surgical therapy of lipoedema - a chronic, progressive, and painful fat distribution disorder. We aimed to assess the clinical effectiveness and safety of liposuction in patients with lipoedema (stage I-III) compared to any conservative treatment, concerning patient-relevant outcomes, such as reduction of pain, reduction in the size of extremities, improvement in quality of life (QoL), and safety events. Methods A systematic review was conducted, and five databases were searched. In-/exclusion criteria were predefined according to the PICOS scheme. The internal validity of the included studies was assessed using the IHE checklist; strength of evidence for safety outcomes by the GRADE approach. Results Six prospective uncontrolled trials (467 patients) were included for assessment of clinical effectiveness. Pain outcomes (patient-reported) statistically significantly improved at six-months follow-up and up to 12 years after liposuction (six studies). Reduced sizes of patients' extremities before-and-after liposuction were reported in three studies regarding reduced leg volume and circumference of lower extremities. Statistically significant improvements in lipoedema-related QoL outcomes were reported in four studies. Seventeen post-operative adverse events occurred overall (492 patients, one additional retrospective study), including five serious adverse events. Other reported procedure-related adverse events comprise, e.g., post-operative wound infections and bleedings. Studies were judged with moderate/high risk of bias. Strength of evidence for safety outcomes was judged to be very low. Conclusions The current evidence is insufficient to prove that tumescent liposuction as safe as und more effective than conservative therapy for lipoedema. However, based on the limited evidence of the included uncontrolled studies, liposuction may potentially reduce lipoedema-associated clinical symptoms and improve the QoL. Key messages Based on the limited evidence of identified uncontrolled studies, liposuction may potentially reduce lipoedema-associated clinical symptoms and improve the quality of life of affected females. High-quality comparative studies need to be awaited. The results may support and influence the effect estimates considerably.