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The treatment of lymphoedema of the lower limbs is often rather disappointing, at the present time. However, two simple surgical techniques, lympho-venous anastomosis and lymphatic drainage, seem to complement existing methods and should improve the clinical course of constitutional and secondary lymphoedema. These simple techniques are based on the pathophysiology of the lymphoedema and certainly represent a hope in the treatment of some swollen legs.

In the management of moderately severe lymphedema of the extremities, two types of "physiological" surgery have been employed with acceptable results. The methods involve (1) subcutaneous drainage of lymph by a synthetic suture network or loops of #2 prolene and (2) lymphatic-venous anastomosis of lymphatic channels into adjacent superficial veins. In 126 patients treated by the first method, there was an average reduction of edema of approximately 60%. In 77 patients the second method (306 anastomoses) resulted in an average reduction of edema of 75% in follow-up rangeing up to 11 years. These procedures are contraindicated in patients with limb paralysis or frequent recurrent skin infection.

The authors introduce a new technique of lymphatic-venous anastomosis in cases of lymphedema of the limbs. The anastomosis is of buried type and is described in detail. The procedure is easy, practical and can be indicated for both the upper and lower limbs, and also for thoracic duct or anyone blocked lymphatic of the abdomen. In all cases, we did lymphangioadenography and phlebography and in some cases arteriography. Our experience consists of 81 patients with 89 operations with 302 anastomoses of lymphatic vessels blocked by some disease or surgical resection of benign tumors or consequent to plastic surgery (abdomen pendulous, resection of lipomas of the inguinal region of the thigh, plastic surgery of the thigh), orthopedic operations on the knee or to the stripping of varicose veins. The purpose of the procedure is to divert the lymph to the vein in cases of blocked lymphatic vessels, particularly when lymphographic findings demonstrate good functional and good permeability of lymphatic vessels. Six operations failed in five patients (in one patient: two operations); the anastomoses failure occurred in the first cases operated on, when we did one or two anastomoses and had not learned some faulty details of technique. An average reduction of 76% of the edema was achieved. The reduction is in proportion to the number of anastomoses. Anastomoses as a routine, whenever possible, must be over five in number. We insist in the number of anastomoses because we must consider that some of them can be lost by thrombosis or by faulty technique.(ABSTRACT TRUNCATED AT 250 WORDS)