Case series of genital lymphaticovenous anastomosis for genital lymphatic vesicles

The management of lymphatic vesicles is challenging. This study aimed to clarify the lymphatic flow around the genitals and assess the effect of genital lymphaticovenous anastomosis (LVA) on lymphatic vesicles.

We conducted a retrospective study of 34 patients who underwent lymphatic vesicle resection and LVA. In patients with genital lymphedema, 2 types of lymphatic inflow existed around the genital area; from the lower extremities (type 1) and from the buttocks (type 2). Lymphoscintigraphy was performed to detect type 1 lymphatics injecting isotope into the first interdigital area. Indocyanine green (ICG) lymphography was performed to detect type 2 lymphatics injecting ICG into the ischial tuberosity. Lymphatic vesicles were resected, and LVA was performed on the legs and/or genitals. Postoperative recurrence rate of lymphatic vesicles and the frequency of cellulitis were evaluated.

Type 1 lymphatics were observed in 38.2% of the patients. ICG lymphography showed a linear inflow to the genitals in 40.9% and dermal backflow inflow in 24.2%. Both type 1 and 2 lymphatic vessels were observed in 10 patients (29.4%). Genital LVA was performed in 31 patients and lower extremity LVA was performed in 15 patients. The average follow-up period was 332 days, and recurrence was observed in 8 (25.8%) of 31 patients who underwent total resection. The average number of cellulitis episodes decreased significantly from 2.8 times before surgery to 0.31 times after surgery (p < 0.01).

LVA in the genital area and lower limbs was effective in preventing postoperative recurrence of lymphatic vesicles after resection.