Lymphatic Venous Anastomosis
[What is Lymphatic-Venous Anastomosis (LVA) under local anesthesia?]
Here we will describe the mechanism of lymphatic-venous anastomosis (LVA). The typical intra-lymphatic pressure after lymphadenectomy is known to raise over 100 mmHg. This is much higher than the normal venous pressure of 10 mmHg. Hence, when the lymphatic vessel and the vein is directly anastomosed, the lymph flows from the lymphatic vessel into the vein through the bypass aided by this pressure gradient and the abnormally high intra-lymphatic pressure is believe to return to near venous level. Conventional conservative therapies are considered as symptomatic treatments (i.e. the treatment targets to improve the symptoms), whereas the LVA procedure places focus on the pathology of the increased intra-lymphatic pressure and aims for cure. Moreover, enhanced mitigating effect of the edema can be achieved for cases with a viable lymphatic-venous bypass by adding conservative therapies such as lymph draining and using compression stockings post-operatively. The low-invasive nature of the procedure done under local anesthesia allows patients even over 90-years-old to be suitable for surgery. The LVA procedure is typically 2-3 hours long with an average amount intra-operative bleeding of 5cc or less. The average post-operative hospitalization period is 4-7 days.
■ Standard Treatment Schedule:
from admission to discharge
Please note that schedule may differ for patients coming from foreign countries. Please contact us in advance for details.
Day 1 (Tuesday: the day before surgery)
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Patient admitted for pre-operative monitoring and management (by plastic surgeon).
Day 2 (Wednesday: surgery day)
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Surgery scheduled from 9:00am to noon (by Dr. Makoto Mihara).
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Patient will be able to ambulate after the surgery but only for a short duration of ~30min. (e.g. going to the washroom).
Day 3 (the day after the surgery)
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The wound areas will be checked and a waterproof tape will be attached. From then the patient will be able to take shower.
Day 5 and beyond
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If the wound areas are clean, the patient can be discharged. The patient will resume compression stocking therapy after discharge.
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