Comparative Analysis between Side-to-End and End-to-End Lymphaticovenous Anastomosis for Secondary Lower Limb Lymphedema

Introduction The purpose of this retrospective study is to describe, evaluate and compare the outcome between end-to-end (ETE) and side-to-end (STE) LVA for all stages of lymphedema. Material and Method: Total of 123 patients were divided into ETE (n=63) or STE (n=60) group. The demographics, intraoperative and postoperative findings were evaluated. In addition, subcategory evaluation was performed for early and advance phase lymphedema. Result: The demographic findings were insignificant. The intraoperative findings showed significantly higher number of LVAs performed for the ETE group (4.1±1.7) over the STE group (3.2±1.2) (p<0.001) while the number of different lymphatic vessels used per patients was not significant (3.4±1.4 vs 3.2±1.2, p=0.386). The diameter of the lymphatic vessels were not significant (0.43±0.06 vs 0.45±0.09mm, p=0.136). While both groups showed significant postoperative volume reduction, STE group had a significantly better reduction in all time intervals (p<0.03) and for longitudinal outcome (p=0.004). However, the subcategory evaluation for early phase patients showed no difference between the two groups while significantly better volume reduction ratio noted for the STE group at all time intervals (p<0.025) and overall longitudinal outcome (p=0.004) in advanced lymphedema patients. Conclusion: This is the first study to report the efficacy of ETE versus STE LVA in difference phases of lymphedema. Although both ETE and STE LVAs are significantly effective in volume reduction, there was a significantly better reduction for the STE group in advanced phase lymphedema patients with stage II late and III while no difference was noted for early phase lymphedema patients.