Lymphovenous anastomosis (LVA) for treatment of iatrogenic lymphocele in the thigh.

BACKGROUND: Lymphocele is a collection of lymphatic fluid within the body. It is caused by an impairment of lymph drainage and often occurs after a surgical intervention. In this setting conservative treatment is usually ineffective. The aim of this report is to share the outcomes of 11 patients with iatrogenic lymphocele in the thigh area treated by supermicrosurgical lymphovenous anastomosis. PATIENTS AND METHODS: Eleven patients presenting iatrogenic lymphocele in the thigh were referred for surgery after an unsuccessful conservative therapy. Patients' mean age was 56 years old, two males and nine females. All of them presented a moderate-to-severe lymphocele in the medial thigh after a surgical intervention that damaged the rich lymphatic pathway present there. Indocyanine green (ICG) lymphography was always performed to visualize the lymphatic vessels and to make the preoperative marking. RESULTS: All the 11 patients were successfully treated by means of one or more (range: 1-3; mean: 1.5) lymphaticovenous anastomoses without complications. Three of them also received a pedicled sartorius flap for dead space obliteration. All the patients reached full range of motion (ROM) and no recurrences were observed during follow up (range: 6-12 months; mean: 8). Intra-operative ICG lymphography was performed in all cases to check the patency of the anastomoses. CONCLUSIONS: Lymphaticovenous anastomosis confirmed to be a minimally-invasive and effective procedure for the treatment of postsurgical lymphoceles in the leg. For large lymphoceles a muscle flap may be indicated for volume restoration and prevention of recurrences.

Lymphovenous anastomosis (LVA) for treatment of isolated penile lymphedema: A case report.

Isolated penile lymphedema is a rare but severely disabling condition due to reduced lymphatic drainage. In this area treatment opportunities are poor being that conservative management is usually not effective and surgery limited to debulking lymphangiectomy, which is indicated only in very severe cases. Lymphovenous anastomosis (LVA) has a demonstrated efficacy in treatment of upper and lower limbs lymphedema but still has few applications in genital lymphedema and none when the swelling is confined in the penis. Here we present a case of an isolated penile lymphedema treated with super-microsurgical LVA. A 33-year-old patient presented swelling and pain immediately after a traumatic injury at the base of the penis. After 2 years of conservative praxis with manual lymphatic drainage of the penis and upper thigh bandage compression, no improvement of the symptoms was obtained. Indocyanine green lymphography was performed with dye injection in the glans confirming the diagnosis by showing lymphatic drainage stasis (dermal backflow). We consequently decided to undergo a surgical procedure performing lymphovenous anastomosis at the dorsum of the penis. Immediately following this intervention, both objective and subjective symptoms relief were noted with decrease of swelling and pain. The postoperative course was uneventful and at the 6 months follow up the patient reported no recurrence of the swelling even with the complete removal of compression therapy. We consider therefore that LVA may be a valid possibility for management of similar cases to provide a definitive clinical improvement.