Lymphoedema trial extended by a year after 100% of patients report reduced pain

Updated: 

A trial into specialist treatment of a debilitating condition that causes misery to thousands of sufferers has proved so successful that it has been extended for another year.

Lymphoedema, which is thought to affect 200,000 people nationally, is the accumulation of lymph fluid that can lead to swollen limbs that leak fluid, decreased mobility, pain and frequent admission to hospital with cellulitis - a potentially serious infection.

The chronic and previously incurable condition is being successfully treated by surgeons at Neath Port Talbot Hospital in Port Talbot, South Wales.

The hospital is the only place in the UK where super-microsurgery on people with lymphoedema is carried out on the NHS and a two-year evaluation of the benefits has proved so successful after just 12 months that it has already been extended by a further year, according to the Abertawe Bro Morgannwg University (ABMU) health board.

Originally, all the procedures were to be carried out by consultant plastic surgeon Amar Ghattaura, who was the only trained super-microsurgeon in Wales, but he has since been joined by microsurgeon Tom Bragg, who is also a sarcoma cancer surgeon.

Mr Ghattaura said: "We've done around 48 procedures with good results so far. There is, however, a demand to increase the numbers in the long term to better serve the lymphoedema population of Wales.

"Tom has really enhanced the service in making sure we complete procedures in a timely fashion and improving the number we can perform."

Lymphoedema is caused by damaged or removed lymph nodes following cancer treatment or surgery, as well as non-cancer conditions. The NHS says that the condition affects around 20% of women with breast cancer, 50% of vulval cancer sufferers and 30% of men with penile cancer.

Many people have to wear compression garments for the rest of their lives, while others need medication to control infection.

In 2015, Wales started offering lymphatic venous anastomosis (LVA) on the NHS, provided by the Lymphoedema Network Wales in partnership with ABMU. It uses super-microsurgery to bypass damaged lymph vessels.

The Welsh Government invested £773,000 for up to 42 patients to be treated annually as part of an evaluation of the benefits.

The full benefits may not occur until up to three years after surgery, but no patient who underwent LVA at Neath Port Talbot has since developed cellulitis, freeing hospital beds and reducing antibiotics, the ABMU has said.

Six have already stopped wearing compression garments and have been discharged from the lymphoedema service.

Melanie Thomas, national clinical lead for lymphoedema in Wales, said patients with the condition had to make "considerable" changes to their lives due to wearing a compression garment.

"Simple tasks such as washing the dishes and moving their limbs can be affected," she said.

"Many patients complain of pain and heaviness in their limbs. Since having LVA surgery, 100 per cent of patients reported the heaviness had disappeared and pain had significantly reduced."

The success of the service has led to inquiries from the Royal Marsden Hospital in London, which has started a LVA trial, and Liverpool's plastic surgery service, she said.

Mr Ghattaura said: "We're seeing more and more patients and as we are getting better-known, we are getting more and more referrals, not just from Wales but from England too.

"That is good because it means added income, which can fund our research physiotherapist.

"Research is very important part of this work. The data we are collecting goes way beyond current literature published from European and Japanese units working in LVA."