Some Quebecers suffering from lymphedema — a chronic, aching condition that often results in the swelling of the arms or legs — can now turn to a new surgical treatment offered at the Centre hospitalier de l’Université de Montréal.
In a medical first in Quebec, a team of surgeons at the CHUM operated on a 23-year-old man on Jan. 22 to reduce the swelling in his left leg. And on Wednesday, the same team operated on a 34-year-old woman, bypassing lymphatic blockages in both her legs.
It’s estimated that more than 150,000 Canadians are afflicted with lymphedema. Some are born with the condition, but about 10 per cent of cancer patients develop it after surgery and radiotherapy causes damage to their lymphatic system.
Normally, lymph fluid, containing infection-fighting white blood cells, flows through the body unimpeded. Lymphedema arises when the fluid collects in certain parts of the body, causing chronic swelling.
Until now, the treatment of lymphedema in Quebec was limited to physiotherapy and the wearing of uncomfortable compression garments. Today, thanks to the medical advance at the CHUM, Quebecers with less severe lymphedema will be eligible for the surgical procedure, known as a lymphovenous bypass.
“This is really a marriage between technology and medicine,” said plastic surgeon Ali Izadpanah, who learned the technique at the Mayo Clinic in the U.S.
“Until now, Canadian patients with lymphedema have been going to the U.S. to seek surgical treatment. It could cost anywhere from $40,000 to $60,000.”
Michel-Alain Danino, chief of plastic surgery at the CHUM who learned the technique in Japan, assembled a multi-disciplinary team to perform the procedure in Quebec.
The bypass requires great skill as it involves what is known as super micro-surgery, stitching lymphatic vessels, that are a fraction of a millimetre, to nearby veins. The surgeons peer through a $460,000 microscope that magnifies images 80 times.
Before carrying out the bypass, the surgeons inject a contrast dye in the swollen limb so that they can see the lymphatic vessels through a special medical-imaging camera. They trace the vessels on the skin using a marker before cutting into the tissue.
Olivier Lagacé, a 23-year-old actuary, underwent the operation on Jan. 22. He developed lymphedema in his left leg after a motorcycle accident in 2014. He sustained burns on his left leg, and five months later, it swelled by 50 per cent.
He had to wear a thick compression garment on his leg all the time, even during the hot summer months. Simple chores, like washing the dishes, soon proved nearly impossible.
Less than two weeks after the operation, Lagacé said he has already noticed a reduction in the swelling below his knee.
“I now have hope,” he said. “Even if I have to wear a compression garment, it won’t be as much pressure as before. It’ll be more comfortable.”