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Massive Localized Abdominal Lymphedema Treatment Challenges.

ABSTRACT: Massive localized lymphedema of the abdomen is a rare condition resulting from a neglected lower abdominal pannus associated with significant disability and morbidity. Compared to other surgical procedures, postbariatric surgery is usually considered a financial drain. In the United Kingdom, this requires National Health Service approval and delays may lead to sequelae that adversely impact on patients' quality of life with increased morbidity. We present a wheelchair-bound patient whose body mass index increased from 53 to 82, while awaiting funding approval increasing her anesthetic and surgical risks. A multidisciplinary approach is mandatory for preoperative, intraoperative, and postoperative care for these patients including anesthetic input and high dependency unit care. Managing this patient was a significant anesthetic and surgical challenge with 47-kg resected tissue. The planning and perioperative measures to minimize morbidity are discussed.

SUBMITTER: Al-Tarrah K

PROVIDER: S-EPMC7015591 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Massive Localized Abdominal Lymphedema Treatment Challenges.

Al-Tarrah Khaled K Ashour Tarek T Rao Rajashankar R Rayatt Sukhbir S Thomas Sunil S SS

Plastic and reconstructive surgery. Global open 20200117 1

Massive localized lymphedema of the abdomen is a rare condition resulting from a neglected lower abdominal pannus associated with significant disability and morbidity. Compared to other surgical procedures, postbariatric surgery is usually considered a financial drain. In the United Kingdom, this requires National Health Service approval and delays may lead to sequelae that adversely impact on patients' quality of life with increased morbidity. We present a wheelchair-bound patient whose body ma ...[more]

PMID: 32095405

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Concurrent bariatric surgery and surgical resection of massive localized lymphedema of the thigh. A case report.

Project description:IntroductionMassive localised lymphedema (MLL) is considered a rare large, pendulous localised benign overgrowth of lymphoproliferative tissue commonly seen in patients with morbid obesity. Histologically, it may be mistaken for well-differentiated liposarcoma; hence, it is also known as pseudosarcoma.Presentation of caseWe describe the successful management of MLL of the left medial thigh in a 35-year-old man weighing 220 kgs (BMI 80.8 kgs/m2). He underwent a concurrent laparoscopic sleeve gastrectomy with surgical resection of the MLL. He recovered well and during our last follow up six months after the operation, he is ambulating well and weighs 148 kgs (BMI 54.4 kgs/m2).DiscussionMLL is a form of secondary lymphedema resulting in disruption or compression of normal lymphatic drainage due to fat accumulation in obese patients. Patients usually delay treatment for even up to a decade, when it becomes sufficiently large enough to restrict mobility and daily activities, or when it becomes infected. MLL is primarily a clinical diagnosis. A detailed history regarding its slow growth spanning over the years makes malignancy less likely. However, if left untreated, MLL may progress to angiosarcoma. Imaging studies such as computed tomography (CT) and a Magnetic Resonance Imaging (MRI) are usually performed to rule out malignancy or vascular malformations. A tissue biopsy is not recommended unless there are suspicious pigmented lesions.ConclusionMLL remains to be underdiagnosed. Due to the obesity epidemic, clinicians must be aware of this once rare disease. The role of concurrent bariatric surgery with surgical resection of MLL warrants further studies.

| S-EPMC6806377 | biostudies-literature

Effects of Ultrasound-guided Lower Abdominal Lymphaticovenous Anastomosis on Lower Abdominal Lymphedema.

Project description:Lymphedema of the lower extremities can be further complicated by lymphedema of the lower abdomen and genitalia. This study aimed to clarify the effect of lower abdominal lymphaticovenous anastomosis (LVA) on lower abdominal lymphedema. The patient was a 61-year-old woman. At the age of 49 years, she underwent treatment for ovarian cancer, including pelvic lymphadenectomy, and she developed lymphedema in the lower abdomen and bilateral thigh 2 years later. During lymphoscintigraphy, isotopes injected into the dorsum of the bilateral feet accumulated in the corresponding areas, indicating that lymph flowed into these areas from the legs. Compression therapy was performed with a girdle; however, its effect was limited. According to the lymphoscintigraphic findings, we performed LVA in the bilateral thighs (two anastomoses each), and the edema symptoms slightly improved postoperatively. However, as edema was still present and the patient sought further relief, we evaluated the lymphatic vessels in the lower abdomen using lymphatic ultrasound and found dilated lymphatic vessels. We performed another LVA in the lower abdomen 1 year after the first LVA (two anastomoses in the right abdomen, one anastomosis in the left abdomen, and an additional anastomosis in the bilateral thighs). The patient's subjective symptoms improved, and ultrasonography showed a reduction in abdominal lymphedema at 7 months follow-up. For lymphedema in the lower abdomen and genital area that does not improve with compression therapy, appropriate examination to evaluate lymphatic flow and lymphatic degeneration is necessary, and LVA in the lower abdomen may be effective.

| S-EPMC10718338 | biostudies-literature

Pharmacological Treatment of Secondary Lymphedema.

Project description:Lymphedema is a chronic disease that results in swelling and decreased function due to abnormal lymphatic fluid clearance and chronic inflammation. In Western countries, lymphedema most commonly develops following an iatrogenic injury to the lymphatic system during cancer treatment. It is estimated that as many as 10 million patients suffer from lymphedema in the United States alone. Current treatments for lymphedema are palliative in nature, relying on compression garments and physical therapy to decrease interstitial fluid accumulation in the affected extremity. However, recent discoveries have increased the hopes of therapeutic interventions that may promote lymphatic regeneration and function. The purpose of this review is to summarize current experimental pharmacological strategies in the treatment of lymphedema.

| S-EPMC8822213 | biostudies-literature

Immediate lymphatic reconstruction for breast cancer-related lymphedema: current status and challenges.

Project description: Not available

| S-EPMC11002484 | biostudies-literature

Acute Lymphedema

Project description:Mouse surgical model of acute lymphedema induction. We performed three sets of microarrays with three replicates each for a total of 9 arrays. Each array was run using pooled RNA from three animals. The three conditions were Normal tail skin (no intervention), Lymphedema tail skin(due to surgical lymphatic vessel blockage), and Surgical Sham control tail skin(surgical incision with no lymphatic vessel blockage). 15ug of test and reference (e17.5 mouse whole embryo) RNA was used for labeling. Set of arrays organized by shared biological context, such as organism, tumors types, processes, etc. Keywords: Logical Set

2006-03-04 | GSE4333 | GEO

Topical tacrolimus for the treatment of secondary lymphedema.

Project description:Secondary lymphedema, a life-long complication of cancer treatment, currently has no cure. Lymphedema patients have decreased quality of life and recurrent infections with treatments limited to palliative measures. Accumulating evidence indicates that T cells play a key role in the pathology of lymphedema by promoting tissue fibrosis and inhibiting lymphangiogenesis. Here using mouse models, we show that topical therapy with tacrolimus, an anti-T-cell immunosuppressive drug, is highly effective in preventing lymphedema development and treating established lymphedema. This intervention markedly decreases swelling, T-cell infiltration and tissue fibrosis while significantly increasing formation of lymphatic collaterals with minimal systemic absorption. Animals treated with tacrolimus have markedly improved lymphatic function with increased collecting vessel contraction frequency and decreased dermal backflow. These results have profound implications for lymphedema treatment as topical tacrolimus is FDA-approved for other chronic skin conditions and has an established record of safety and tolerability.

| S-EPMC5309859 | biostudies-other

Genital Lymphedema after Cancer Treatment: A Narrative Review.

Project description:Genital lymphedema may affect males and females after cancer treatment (gynecological, such as cervical, uterine or ovarian, melanoma, prostate, anus…). It is frequently associated with lower limb lymphedema, and is responsible for discomfort, cosmetic disfigurement and functional disturbances. Impacts on body image, sexual function and quality of life are major, and difficult to explore because cancer treatment itself and lymphedema are so closely interwoven. Local complications, e.g., papillomatosis, warty growth, lymph vesicles with embarrassing lymph oozing and cellulitis, may occur. Usual lymphedema therapies, like bandaging and elastic compression, are poorly adapted to these sites. Surgery, essentially based on cutaneous resection techniques, is the primary symptomatic treatment; it achieves good efficacy, in adults and children, with possible recurrence requiring reintervention.

| S-EPMC9739141 | biostudies-literature

Manual lymphatic drainage for lymphedema following breast cancer treatment.

Project description: Not available

| S-EPMC4966288 | biostudies-literature

The Future of Lymphedema: Potential Therapeutic Targets for Treatment.

Project description:Purpose of reviewThis review aims to summarize the current knowledge regarding the pharmacological interventions studied in both experimental and clinical trials for secondary lymphedema.Recent findingsLymphedema is a progressive disease that results in tissue swelling, pain, and functional disability. The most common cause of secondary lymphedema in developed countries is an iatrogenic injury to the lymphatic system during cancer treatment. Despite its high incidence and severe sequelae, lymphedema is usually treated with palliative options such as compression and physical therapy. However, recent studies on the pathophysiology of lymphedema have explored pharmacological treatments in preclinical and early phase clinical trials.SummaryMany potential treatment options for lymphedema have been explored throughout the past two decades including systemic agents and topical approaches to decrease the potential toxicity of systemic treatment. Treatment strategies including lymphangiogenic factors, anti-inflammatory agents, and anti-fibrotic therapies may be used independently or in conjunction with surgical approaches.

| S-EPMC10233555 | biostudies-literature

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema.

Project description:INTRODUCTION:Analysis of quality of life (QOL) outcomes is an important aspect of lymphedema treatment since this disease can substantially impact QOL in affected individuals. There are a growing number of studies reporting patient-reported outcomes (PROMs) for patients with lymphedema. The purpose of this study was to conduct a systematic review of outcomes and utilization of PROMs following surgical treatment of lymphedema. METHODS:A literature search of four databases was performed up to and including March, 2019. Studies included reported on QOL outcomes after physiologic procedures, defined as either lymphovenous bypass (LVB) or vascularized lymph node transplant (VLNT), to treat upper and/or lower extremity primary or secondary lymphedema. RESULTS:In total, 850 studies were screened-of which, 32 studies were included in this review. Lymphovenous bypass was the surgical intervention in 16 studies, VLNT in 11 studies, and both in 5 studies. Of the 32 total studies, 16 used validated survey tools. The most commonly used PROM was the lymph quality of life measure for limb lymphedema (LYMQOL) (12 studies). In the remaining four studies, the upper limb lymphedema 27 scale (ULL27), the short form 36 questionnaire (SF-36), the lymphedema functioning, disability and health questionnaire (Lymph-ICF), and lymphedema life impact scale (LLIS) were each used once. QOL improvement following surgical treatment was noted in all studies. CONCLUSIONS:Physiologic surgical treatment of lymphedema results in improved QOL outcomes in most patients. The use of validated PROM tools is increasing but there is no current consensus on use. Future research to evaluate the psychometric properties of PROMs in lymphedema is needed to guide the development and use of lymphedema-specific tools.

| S-EPMC7139674 | biostudies-literature

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