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. 2021 Jul;41(5):421-429.
doi: 10.1002/micr.30741. Epub 2021 Apr 3.

Lymphaticovenular anastomosis for lymph vessel injury in the pelvis and groin

Hideki Kadota  1 , Ryo Shimamoto  1 , Seita Fukushima  1 , Yusuke Inatomi  1 , Ko Ikemura  1 , Kayo Miyashita  1 , Kenichi Kamizono  1 , Masuo Hanada  1 , Sei Yoshida  1
Affiliations

Lymphaticovenular anastomosis for lymph vessel injury in the pelvis and groin

Hideki Kadota et al. Microsurgery. 2021 Jul.

Abstract

Background: Lymphatic diseases due to lymph vessel injuries in the pelvis and groin require immediate clinical attention when conventional treatments fail. We aimed to clarify the effectiveness of and indications for lymphaticovenular anastomosis (LVA) to treat these lymphatic diseases.

Methods: We retrospectively evaluated six patients who underwent LVA for lymphatic diseases due to lymph vessel injuries in the pelvis and groin. Specific pathologies included groin lymphorrhea (N = 3), chylous ascites (N = 2), and retroperitoneal lymphocele (N = 1). The maximum lymphatic fluid leakage volume was 150-2600 mL daily. Conventional treatments (compression, drainage, fasting, somatostatin administration, negative pressure wound therapy, or lymph vessel ligation) had failed to control leakage in all cases. We performed lower extremity LVAs after confirming the site of lymph vessel injury using lymphoscintigraphy. We preferentially placed LVAs in thigh sites that showed a linear pattern by indocyanine green lymphography. Postoperative lymphatic fluid leakage volume reduction was evaluated, and leakage cessation was recorded when the drainage volume approached 0 mL.

Results: LVA was performed at an average of 4.3 sites (range, 3-6 sites) in the thigh and 2.7 sites (range, 0-6 sites) in the lower leg. Lymphatic fluid leakage ceased in all cases after a mean of 6 days (range, 1-11 days) postoperatively. No recurrence of symptoms was observed during an average follow-up of 2.9 (range, 0.5-5.5) years.

Conclusions: LVA demonstrates excellent and rapid effects. We recommend lower extremity LVA for the treatment of lymphatic diseases due to lymph vessel injuries in the pelvis and groin.

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References

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