Simultaneous bilateral lympho-venous anastomosis (LVA) is a newly introduced surgical treatment available at Leeds Teaching Hospitals NHS Trust for patients with lymphoedema.
Lymphoedema causes chronic swelling, usually in the arms or legs due to fluid buildup. The operation is done on both affected limbs at the same time, and significantly reduces the severity of the swelling, allowing the patient to live a normal life.
Only a few other centres in England offer this advanced surgery and it is the first time it has been made available to NHS patients in Yorkshire.
The dual-limb procedure was performed for the first time last Autumn and it has gone on to improve the lives of more than 100 people living with the condition, including Emma Moulds, 38, from Baildon.
Emma had the lymph nodes in her arms removed as part of treatment for breast cancer in 2023. She said: “Having to deal with lymphoedema as well as my cancer treatment was incredibly difficult. Even normal day-to-day activities became a constant challenge. While my cancer treatment was looking successful, I realised I would have to manage symptoms of lymphoedema for the rest of my life – but this new surgery has completely turned things around.”
Lymphoedema is thought to affect around 400,000 people in the UK. It is a long-term condition that develops when the lymphatic system, which helps fight infection and remove excess fluid, does not work properly.
Sometimes lymph nodes have to be removed as part of cancer treatment, which can result in disruption to the channels that remove fluid, leading to excessive swelling. This can cause serious mobility issues and it can be difficult to fit into clothes.
There’s no cure, but it’s usually possible to control the symptoms to a degree. Without treatment, it will usually become more severe and persistent over time.
“Having to deal with lymphoedema as well as my cancer treatment was incredibly difficult. Even normal day-to-day activities became a constant challenge.” – Emma Moulds, patient
“My arms swelled up and became heavy to move, and I went up two sizes almost overnight,” recalled Emma. “Things I wouldn’t think twice about doing normally became incredibly difficult. I had to sell my car and get a smaller one, I needed a special desk chair to support my arms when I was working, and I couldn’t exercise because it was too painful.”
This included riding and looking after her horses. “Horses are my passion in life,” Emma said, “so the realisation I could no longer do what I love was gutting. When I heard about the potential of the new treatment in Leeds I leapt at the opportunity.”
LVA is a specialist microsurgical procedure which involves redirecting the lymphatic fluid into a nearby vein. This allows the lymph fluid to circulate back into the rest of the body, avoiding the vessels that are no longer working. Surgeons operate on both affected limbs at the same time, cutting operating times and getting patients back to their old lives, sooner. The surgery is usually done as a day case, which means patients do not need to stay in hospital overnight.
“It took a few hours to complete,” Emma recalled, “once the anaesthetic had worn off, I was back home the same day.”
Emma was out of her bandages in two weeks, and after six weeks, her swelling had reduced considerably. She said: “My wrists reduced in size by 4-5cm and I dropped three sizes – I had to get a full new wardrobe!”
Mr Amr Elbatawy, Consultant Plastic Surgeon, said: “This is a really exciting development in what we can offer patients with lymphoedema in West Yorkshire. For patients like Emma, this procedure has the potential to make a profound difference in quality of life – reducing limb swelling, heaviness, and infection risk, while improving mobility and comfort in daily activities. It represents a significant advance in how patients can manage this challenging condition.
“I’d highly recommend LVA to anyone with lymphoedema, especially to post-cancer patients. It has made such a big difference for me – I can take part in family fun and look after my horses again. It really has given me a new lease of life.” – Emma Moulds, patient
“For Emma, it allowed her to claim back her life following cancer treatment, but this is also an operation that can prevent lymphoedema from occurring in the first place for those who are at higher risk.”
After having lymph nodes removed, the risk of developing lymphoedema in the affected area increases by 40%. This risk is increased further if you are having radiation as part of cancer treatment. This new procedure can reduce the risk of developing lymphoedema after nodes are removed to just 10%.
Emma said: “The new treatment has been life-changing. Without the operation I’d be looking at living with lymphoedema for the rest of my life. I’d highly recommend LVA to anyone with lymphoedema, especially to post-cancer patients. It has made such a big difference for me – I can take part in family fun and look after my horses again. It really has given me a new lease of life.”
Mr Elbatawy, said: “This marks a major milestone in the development of our lymphatic surgery service in Leeds and it establishes a new pathway for treating lymphoedema locally, offering patients access to advanced microsurgical options that were previously unavailable in West Yorkshire. Currently, only a few other NHS trusts in the country offer this.”
Referrals can be made from a GP practice via lymphoedema nurse specialists, breast surgeons or medical secretary to consultant plastic surgeons Mr Amer Hussain, Mr Waseem Bhat and Mr Amr Elbatawy. The procedure is conducted at Leeds General Infirmary. More information can be found on the lymphoedema webpage.