Surgical Treatment of Lymphedema

Lymphedema is a chronic condition characterized by impaired lymphatic drainage, leading to the progressive accumulation of protein-rich fluid in tissues. Without treatment, lymphedema tends to worsen over time, which is why early intervention is crucial for achieving better outcomes. While the condition is incurable, lymphatic surgery in Israel can significantly reduce its symptoms and improve quality of life.

The lymphatic system plays a vital role in fluid regulation and waste removal. Normally, about 90% of fluid in tissues is absorbed by the venous system, while the remaining 10%—including lymph, proteins, and waste products—is handled by the lymphatic vessels and nodes. Lymph eventually drains into the venous system via the thoracic duct.

In patients with primary lymphedema in Israel (a congenital disorder) or secondary lymphedema in Israel (resulting from trauma, cancer treatment, or infections), this drainage is disrupted. The fluid builds up, causing swelling, fibrosis, and sometimes skin thickening or hair loss. If left untreated, lymphedema can lead to disfigurement, pain, and functional impairment of the limbs.

There are two main types:

• Primary lymphedema is due to congenital malformations of the lymphatic vessels. It is rare, affecting about 1.15 per 100,000 people under the age of 20. Common causes include Noonan-Milroy syndrome and distichiasis.

• Secondary lymphedema arises from external damage or obstruction of lymphatic flow—such as cancer surgery, radiation, trauma, or infection. It is more common and frequently affects patients with obesity or chronic illnesses. Globally, the leading cause is filariasis, a parasitic infection transmitted by mosquitoes.

Lymphedema varies in severity. Each stage can affect mobility and daily life, and untreated cases may lead to recurrent infections, discomfort, or social isolation:

• Stage 0: Subclinical. No visible swelling, but lymphatic flow is impaired. Common in patients post-lymph node removal.

• Stage 1: Mild swelling (<20% limb volume increase) with fluid accumulation and possible pitting. Elevation may help.

• Stage 2: Moderate swelling (20–40%), non-pitting, with fat deposition and fibrosis.

• Stage 3: Severe swelling (>40%), thickened skin, fibrosis, and in some cases, elephantiasis.
  

At Sourasky Medical Center, both conservative and surgical approaches are used.

Early-stage patients may benefit from:

• Manual lymphatic drainage (MLD)

• Compression bandaging and garments

• Therapeutic exercises

• Skin care and infection prevention

For moderate to severe cases, especially when conservative methods are insufficient, advanced surgical treatment of lymphedema in Israel is available:

• Liposuction: For chronic cases with high fat deposition.

• Lymphatico-venous anastomosis (LVA): Microsurgical connection of lymph vessels to nearby veins.

• Vascularized lymph node transfer (VLNT): Transfer of healthy lymph nodes to the affected area to restore drainage. This innovative procedure can reduce swelling and improve function.
  

Before surgery, advanced imaging such as lymphoscintigraphy and CT angiography is performed to map the lymphatic and vascular systems. These tools are critical for minimizing risk and enhancing surgical outcomes.

Surgery is typically low-risk, but full recovery requires time. In the first two weeks, pressure should be avoided at the surgical site to allow grafted nodes to establish blood supply. Regular physiotherapy and compression therapy remain essential.

Initial swelling may worsen temporarily due to surgical trauma. However, over 6–12 months, transferred nodes form new lymphatic pathways, and significant improvement in lymphedema symptoms can be expected.

Sourasky Medical Center provides no wait lymphedema surgery with a multidisciplinary team of specialists. Patients seeking lymphedema treatment in Israel benefit from personalized care, high safety standards, and state-of-the-art facilities.

To begin the evaluation process, contact our international coordination team and receive expert guidance within 24–48 hours.