Lymphovenous anastomosis in filarial lymphedema

Correction of established filarial edema requires lymphaticovenous by-pass, to overcome the lymphatic obstruction and debulking to reduce the lymphatic load. Lymphnodovenous shunt at inguinal area has given 90% success in the authors hand, proving the by-pass. However, in an enormously swollen leg the dilated distal lymphatics may not be adequately drained and hence a distal lymphaticovenous anastomosis should theoretically offer further reduction; and thereby make debulking effective. In this article 3 cases are reported in whom lymphovenous anastomosis was done, in 2 at the knee level and in 1 at the ankle, their result and rationale are discussed.