Lymphovenous Anastomosis (LVA)
LVA is a type of super-microsurgery, a surgical speciality that allows surgeons to operate on structures as small as 0.3mm, using advanced microscopes and instruments. Mr Ghattaura has pioneered super-microsurgery in Wales and has developed the expertise and equipment required for this highly specialised surgery. This development is really exciting for lymphoedema patients, as it deals with the underlying malfunction of the lymphatics.
The LVA surgery joins blocked lymphatic vessels to similar sized veins nearby, using sutures that are finer than your hair. At the end of this surgery, your lymphatic vessels should be re-routed to open, working veins, ‘unloading’ your lymphatic system. As a result, your limb swelling should reduce and your risk of infection will dramatically decrease. The surgery is fairly low risk with minimal scarring and you can expect a rapid return to work and daily activities. In most cases of lymphoedema, LVA surgery is the first-line treatment for Mr Ghattaura’s patients.
The lymphoedema MDT Clinic
To undergo this surgery, you will first need to see Mr Ghattaura in his combined Lymphoedema MDT Clinic, with his lymphoedema therapists. Together, they will fully assess your leg or arm and also take comprehensive measurements. Mr Ghattaura may then inject dye into your foot or ankle and then use an infrared camera to identify any blockages in your lymphatics. You should be able to see these blockages yourself - they often correlate to areas you always knew were a concern. If suitable, you will then be put forward for LVA surgery.
What’s involved in the procedure?
The surgery takes around 3-4hrs and is performed under local anaesthetic (with you awake). Mr Ghattaura commonly uses 3-5 small incisions on your leg or arm, to access the underlying lymphatics and veins. To manage these extremely small lymphatics (0.3mm-1mm in size), Mr Ghattaura uses a super-microsurgery level microscope as well as very fine instruments. After identifying all of the lymphatics through the opening, he will detach the blocked lymphatics and reattach them to nearby, open veins. These incision sites are then closed with non-dissolvable stitches; Mr Ghattaura will then apply small dry dressings and a light garment. You will normally be discharged home after a few hours.
You should take it easy for the first few days after surgery, but after that, you can recommence light activities. Your stitches will be removed at 2 weeks, either by the lymphoedema therapists or by your local GP nurse. Mr Ghattaura recommends you avoid driving for 2-weeks following surgery and strenuous activities for 4-6 weeks.
Super-microsurgery is one of the more recent developments in the treatment of lymphoedema as it allows surgeons to operate on tiny lymph vessels. This surgery offers patients the opportunity to reduce the amount of time they wear compression garments or in some cases, stop using their garments altogether. LVA surgery also significantly reduces the risk of infections that can exacerbate lymphoedema further.