Insights and contrasts between Western and Eastern practices of surgical management of lower limb lymphedema: A systematic review and narrative synthesis.

Objective: This study aims to systematically compare and analyze the similarities and differences between Western and Eastern medical practices in the epidemiology, diagnosis, treatment strategies, and postoperative management of lower-limb lymphedema, to delineate evolving trends and forecast future developments. Methods: A systematic review was undertaken in accordance with PRISMA guidelines. A narrative synthesis was performed in accordance with the Guidance on the Conduct of Narrative Synthesis In Systematic Reviews. Results: The search yielded in 252 articles and 58 studies were included. Western regions report higher rates of secondary LLL from aggressive oncologic lymphadenectomy, whereas Eastern populations see many cases related to endemic filariasis (with prophylactic microsurgeries like lymphovenous anastomosis (LVA) often employed). Diagnostic approaches differ: Western centers favor imaging (magnetic resonance lymphangiography (MRL), computed tomography lymphangiography (CTL), and lymphoscintigraphy) while Eastern centers rely on real-time methods (indocyanine green (ICG) lymphography, ultrasound) to assess lymphatic function. Variation in surgical approaches reflects differences across regions in practical factors such as patient profiles and institutional resources: Eastern surgeons frequently employ physiological reconstructions (LVA, vascularized lymph node transfer (VLNT)) even at earlier stages, whereas Western practice historically emphasizes excisional debulking (suction-assisted protein lipectomy (SAPL), Charles'procedure) for advanced cases. Emerging techniques also show regional nuances: Western practices explore autologous lymphatic grafts and preventive lymphatic microsurgical preventive healing approach (LYMPHA), while Eastern innovations include lympholymphatic bypass and integrative microsurgical-regenerative approaches. Postoperatively, Western management stresses early mobilization, decongestive physiotherapy, and high-pressure compression, whereas Eastern care often incorporates traditional modalities (acupuncture, herbal therapies) and gentler bandaging. Conclusion: Despite the clear differences that have existed between the West and the East in the past, there is a growing convergence of West-East paradigms: hybrid models combining precise surgical techniques and complementary therapies are being developed, aiming to leverage each region's strengths and improve global LLL outcomes.