Liposuction for chronic lipoedema

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 8 before-and-after studies. It is presented in the summary of key evidence section in the interventional procedures overview. The committee also considered safety data from a coroner's regulation 28 letter. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: patient-reported outcomes including quality of life, and reduction in the volume of lipoedema.

The professional experts and the committee considered the key safety outcomes to be: pain, bleeding, infection, fat embolism, deep vein thrombosis, fluid imbalance and toxicity from local anaesthetic.

There were 29 commentaries from patients who have had this procedure that were discussed by the committee.

The committee was delighted to receive detailed patient commentary and input from patient organisations. The patient commentary was mostly positive about the procedure and highlighted the serious nature of lipoedema.

The committee was informed that lipoedema was common, under-recognised and extremely debilitating.

The committee recognised that there were currently limited treatment options for this condition and that there was a need to define the most safe and effective treatment for it. The committee also recognised that there needs to be more research into patient selection, to understand who would benefit most from this procedure. These factors underpinned the recommendation for further research.

The committee noted that this condition is distinct from obesity and lymphoedema.

The committee noted that liposuction is often a multi-stage procedure, depending on the extent of fat deposition. Furthermore, liposuction may not be a curative procedure and multiple procedures may be needed.

The committee was informed that several different liposuction techniques are used and that they may have different safety and efficacy profiles.

The committee acknowledged that a randomised controlled trial was currently in progress in Germany and that NICE will review this guidance upon publication of this trial.

The committee encourages the creation of a registry for all patients having liposuction for chronic lipoedema to support research.