Abstract Background Obesity is a well-established independent risk factor for lymphedema, and when these conditions co-exist, they present unique surgical and quality-of-life challenges. Traditionally managed separately, we describe a novel one-stage combined surgical strategy—Bariatric Lymphedema One-Stage Operative Management (BLOOM) which addresses both conditions concurrently by repurposing gastroepiploic lymph nodes during sleeve gastrectomy for vascularized lymph node transfer (VLNT). Methods Three patients with lower limb lymphedema (ISL Grade 2–3) and class I–II obesity (BMI 33–37) underwent simultaneous laparoscopic sleeve gastrectomy and VLNT using the gastroepiploic lymph nodes harvested along with the sleeve gastrectomy specimen. All patients had concomitant lymphovenous anastomosis and liposuction of the affected extremity. Intraoperative coordination between bariatric and reconstructive teams enabled efficient flap harvest and minimized ischemia time. Limb volume changes, BMI, incidence of cellulitis, and patient-reported outcomes were assessed over a 6-month follow-up. Results All three patients experienced uneventful recoveries and were discharged by 7 days post-operatively. At 4–6 months follow-up, average BMI reduction was by 5.3 points (range 3.5–7.2), and mean limb volume decreased by 32%. Patients had good resolution of recurrent cellulitis. Patient satisfaction was high, citing improved mobility, reduced limb heaviness, and psychological benefit. There was no donor site morbidity or intra-abdominal complications. Notably, repurposing gastroepiploic lymph nodes avoided traditional donor-site morbidity seen in VLNT (for example, axilla, neck or groin). Conclusion The BLOOM technique offers a safe, efficient, and innovative approach to treating patients with concurrent obesity and lymphedema. This technique not only simplifies VLNT harvest during sleeve gastrectomy but also mitigates donor site complications. Early outcomes suggest synergistic improvement in lymphedema management and metabolic health. Further longitudinal studies with larger cohorts are needed to validate the long-term efficacy of this combined approach.
Wong et al. (Thu,) studied this question.