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Summary
The majority of patients can be managed conservatively. Few patients are suitable for bypass surgery: when surgery is indicatd an enteromesenteric bridge is probably the best form of bypass, having a spectacular effect in about half of the patients. Bypass surgery should be reserved for patients with gross limb swelling that interferes with limb function. Patients with really gross limb swelling and severe skin changes are best treated by a Charles reduction, combined with a local excision of enlarged thigh tissue. Homan's operation should be reserved for those with a moderate to severe degree of swelling. Patients with secondary lymphoedema caused by malignancy often have associated venous oedema. The results of reduction surgery under these circumstances are extremely poor.
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