Barcelona Consensus Paper on Reconstructive Lymphedema Surgery: A Delphi Study

Background: Lymphedema, a chronic condition characterized by accumulation of lymph fluid due to malfunction of the lymphatic system, remains a significant clinical challenge despite advances in diagnosis and treatment. Given that lymphatic surgery is an important therapeutic option, the aim of the present study was to establish an expert consensus on recommendations for improving the surgical management of lymphedema. Methods: This was an international consensus study involving a modified nominal group and Delphi process. During the World Symposium for Lymphedema Surgery in 2023, the steering group invited five experts to participate in a nominal group with the aim of drawing up a set of seven preliminary recommendations. These recommendations were then evaluated and revised by a panel of 31 international experts in a two-round Delphi process. The threshold for consensus was set at a minimum of 70% agreement among panelists. Results: Consensus regarding the content of the seven recommendations was high (mean overall agreement of 79.6%). Agreement was highest for the recommendations concerning specific techniques of reconstructive surgery, measures for preventing lymphedema and its clinical assessment, and post-intervention follow-up protocols. Conclusions: The consensus recommendations on the surgical management of lymphedema highlight the importance of preoperative preparation of patients and careful clinical assessment. Also recommended is the use of preventive surgical procedures, including the combination of reconstructive and reductive techniques, along with multidisciplinary monitoring and follow up. Although these guidelines hold promise, further studies are required to evaluate their implementation and explore their impact on patient health outcomes.