Factors influencing response to lymphonodovenous shunt in filarial lymphoedema

Background. Although several studies have been published on lymphonodovenou s shunt, there are no objective data either on the outcome of lymphoedema o r on various parameters likely to influence the results. Methods. A trial of lymphonodovenous shunt was carried out in 75 patients w ith unilateral filarial lymphoedema. The primary aim of the vial was to ide ntify a cohort of responders as against non-responders and to correlate the outcome with various factors such as age, gender, duration and preoperativ e grade of lymphoedema, number of preoperative attacks of adenolymphangitis , operative impression of the lymph node, effect of venous reflex and type of nodovenous anastomoses. Change In oedema volume was measured objectively by water displacement method using the normal limb as a control. Results. There was no operative mortality. Predominant postoperative compli cations included wound haematoma (8.5%), wound infection (13.6%) and transi ent lymphorrhoea (13.6%). In the immediate postoperative period, a reductio n of 25%-50% in the oedema volume was recorded in 46.7% of cases and of mor e than 50% in 17.3% cases. The difference in response with respect to the t ype of lymphonodovenous shunt was not statistically significant, although t he end-to-side type of shunt showed marginally better results. The response was significantly higher in patients with preoperative oedema volume more than 2 L. There was a significant reduction In postoperative attacks of ade nolymphangitis, irrespective of the reduction In oedema volume. Of the 75 p atients, 22 showed regression of oedema volume to preoperative or higher le vels in the postoperative phase. A majority (21/22) could be identified as non-responders within 3 months of surgery. Conclusion. The best results of lymphonodovenous shunt were seen In patient s with large-volume lymphoedema, The results are better when combined with early excisional surgery. Other factors did not significantly affect the ou tcome. Nonresponders could be identified within 3 months after surgery. Eve n In patients who did not respond well, a significant decrease in the frequ ency of adenolymphangitis attacks was observed. Higher initial oedema volum e and history of higher frequency (25-50 per year) of adenolymphangitis att acks can be considered as indicators for good response to lymphonodovenous shunt.