Guidance
3 Committee considerations
The evidence
3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 7 sources, which was discussed by the committee. The evidence included 1 systematic review and meta-analysis, 1 systematic review, and 5 before-and-after studies. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.
3.2 The professional experts and the committee considered the key efficacy outcomes to be: sustained reduction in limb volume, improvement in quality of life including discomfort, limb symmetry and mobility, and reduced incidence of cellulitis.
3.3 The professional experts and the committee considered the key safety outcomes to be: pain, postoperative infection (including cellulitis), bleeding, venous thromboembolism and fat embolism, and fluid overload.
3.4 Ten commentaries from patients who have had this procedure were discussed by the committee.
Committee comments
3.5 The committee was informed that there are a variety of techniques used for this procedure and they are not the same as the techniques used for cosmetic liposuction.
3.6 This is not a curative procedure, and its effectiveness depends on the person wearing compression garments for life.
3.7 The committee was informed that liposuction for lymphoedema is typically only done once on a limb.
3.8 The committee was informed that this procedure should only be used when lymphoedema persists despite conventional conservative treatments.
3.9 The committee was informed that liposuction is also used to treat patients with chronic lipoedema. This guidance only covers the use of liposuction for the treatment of lymphoedema, which the committee noted may be easier to diagnose and has a more established treatment pathway than lipoedema.
ISBN: 978-1-4731-4527-6