Liposuction For Chronic Lymphoedema, Interventional Procedures Guidance [Ipg723] From Nice

On 27th April NICE issued updated guidance for the use of liposuction in the treatment of lymphoedema in adults. More than 400,000 people in the UK have lymphoedema, and there are likely to be more people as yet undiagnosed.

The use of liposuction as a treatment option can be beneficial to a particular cohort of patients, and this guidance includes welcome evidence-based recommendations.

NICE has updated its guidance on the use of liposuction for lymphoedema. The original guidance came out in 2008 and was updated in 2017 and the 2022 update takes into account new research published since 2017. The new evidence confirms the safety and efficacy of liposuction for lymphoedema and reinforces the previous guidance.

Treatment

The current conservative treatment for lymphoedema is decongestive lymphatic therapy, involving compression bandaging, skin care and exercise. For some people, manual lymphatic drainage massage that stimulates lymph to move away from the affected limb may also be helpful. In severe and chronic cases, in people with lymphoedema that does not respond to conservative treatment, liposuction can be used. This involves the use of suction to remove fluid and fat through punctures in the skin, and these treatments are not the same techniques as those used for cosmetic liposuction.

The procedure is designed to reduce the size of limbs with advanced lymphoedema where the swelling is predominantly due to fatty tissue deposition rather than fluid. It is therefore of value to a small group of patients with this stage of lymphoedema.

The guidance recommends that the procedure is carried out in a small number of specialist centres with expertise in the surgery with patient selection being carried out by a multidisciplinary team with expertise in managing lymphoedema.

A spokesperson from the British Lymphology Society said

“We welcome this updated guidance and know that it will be of great interest to patients and practitioners alike. Liposuction can improve the lives of those living with chronic oedema, whose condition has progressed to an advanced (fatty) stage, despite having received conventional conservative treatment.

The problem that has emerged in recent years is that NHS funding for the procedure, which was once available, has been much more difficult to obtain, requiring going through the individual funding request process. Most of these requests are being turned down, although there is regional variation.”

Key questions answered:

• What does this updated guidance mean for patients?
• The guidance doesn't really change the current situation but reinforces the existing guidance.
• What does this new guidance mean for practitioners?
• Until a better funding system for this procedure is established very few of these procedures are likely to be carried out in the UK. hat the information may be helpful for any practitioner making a case for funding on behalf of a patient.
• What should someone with lymphoedema who hears about this new guidance do?
• Although the patient may be suitable for the treatment, NHS funding may not be available for it to be carried out. There is regional variation, and the individual should speak to their practitioner.