Refining Lymphovenous Anastomosis: Intraoperative Characteristics Associated With Postoperative Outcomes in Patients with Lymphedema

BACKGROUND: Lymphedema is a chronic condition characterized by impaired lymphatic flow, resulting in limb swelling and tissue changes. With growing interest in surgical treatment, procedures such as lymphovenous anastomosis (LVA) and lymph node to vein anastomosis (LNVA) are increasingly performed, even in advanced cases. However, factors affecting surgical outcomes remain unclear. METHODS: This retrospective study analyzed 114 patients who underwent lymphatic microsurgery (LVA and/or LNVA) between October 2020 and September 2021. Patient demographics, disease characteristics, and intraoperative findings were meticulously recorded, including lymphatic vessel and vein diameters, tissue fibrosis, sclerosis, and lymphatic flow parameters. Surgical outcomes were evaluated based on limb volume reduction and bioelectrical impedance analysis (BIA) over a 12-month follow-up. RESULTS: At 12 months, mean limb volume decreased by 6.91%, and BIA excess volume declined from 6.02 to 5.41 (p < 0.0001). Improved outcomes were associated with larger lymphatic diameter (p = 0.0204), higher numbers of successful LVA sites (p = 0.0209), lower degrees of lymphatic sclerosis (p = 0.0205), reduced peripheral fibrosis (p < 0.0001), and greater water content in surrounding tissue (p = 0.0009). Effective lymphatic flow following anastomosis was also correlated with improved results. CONCLUSIONS: Surgical outcomes of LVA and LNVA are significantly influenced by intraoperative lymphatic and tissue characteristics, underscoring the importance of detailed preoperative imaging and real-time surgical assessment.