Matching primary with secondary lymphedemas across lymphatic surgery in Genoa (Italy) from 1973 until time of COVID-19

Authors report their pluridecennial activity (from 1973 up to today) of research, clinical experience and development of lymphatic surgery in Genoa-Italy, in close collaboration with the worldwide centers of the International Society of Lymphology. Five thousand forty-six cases of patients affected by upper and/or lower limbs, primary and secondary lymphedemas and elephantiasis, between 1973 and 2020 underwent lymphatic microsurgery;and between 2012 and 2020. fibro-lipo-lymph-aspiration. according to lymph vessel sparing procedure (FLLA-LVSP), for latest stages of lymphedema elephantiasis, previously treated by lymphatic microsurgery with partial improvement of the disease. In addition, also morbid obesity related elephantiasis, lipolympheilema/elephantiasis, chylous-lymphatic dysplastic gravitational reflux with complex related syndromes, were treated by tailored surgical procedures, properly combined with tailored medical and nutritional regimens. All patients were followed-up fora minimum of 5 years to over 20 years. Over 96% of patients with earlier stages of disease (initial lymphedema: stage IB and increasing lymphedema: stage IIA) progressively stopped using conservative therapies;and over 80% of patients with later stages (column shaped limb fibrolymphedema: stage IIB, properly called elephantiasis: stage IIIA, and extreme elephantiasis: stage IIIB), significantly decreased the frequency of physical therapies and discontinued compressive garments or stockings. Dennato-lymphangio-adenitis attacks considerably reduced by over 95%. Staging-guided treatment of peripheral lymphedema, according to authors' Genoa protocol, carries out not only the best long-lasting treatment, but also the contextual target of primary (to avoid lymphatic injuries), secondary (early-stage treatment), and tertiary (late-stage treatment) prevention in the potential worsening of the disease.