Microsurgery for groin lymphocele and lymphedema after oncologic surgery

Abstract

Groin lymphocele (GL) is a frequent complication of inguinal lymph node dissection, and conservative treatment is not always successful. Different surgical methods have been used to treat lymphoceles arising from lymphatics injured during groin surgery. However, they all involve the closure of lymphatics merging at the lymphocele, increasing the risk of postoperative lower limb lymphedema or of worsening lymphedema if already clinically evident. We assessed the efficacy of a diagnostic and therapeutic protocol to manage inguinal lymphoceles using lymphoscintigraphy (LS) and microsurgical procedures. Sixteen GL [seven associated with leg lymphedema (LL)] were studied by LS preoperatively and treated by complete excision of lymphocele and microsurgical lymphatic-venous anastomoses between afferent lymphatics and a collateral branch of great saphenous vein. Lower limb lymphatics were identified intraoperatively using Patent Blue dye injection. Nine patients without lymphedema had complete healing of lymphocele and no appearance of lower limb postoperative lymphedema. The other seven patients with associated secondary lymphedema had complete disappearance of lymphocele and a remarkable reduction of leg volume. Four of them completely recovered without the need of any compression garment, after the first year postoperative. Inguinal lymphocele nonresponsive to conservative treatment can be advantageously studied by LS and successfully treated by microsurgical reconstructive procedures, above all if associated to LL.

Lymphatic supermicrosurgery for the treatment of recurrent lymphocele and severe lymphorrhea

“…Not only are our favorable outcomes in line with results from the literature (Boccardo et al, ; Todokoro et al, ; Yamamoto et al, , ), but our report has also several added values. We described the largest series of patients suffering from secondary lymphorrhea successfully treated by lymphaticovenous anastomosis to date.…”

LYMPHA Technique to Prevent Secondary Lower Limb Lymphedema

“…9 Besides functional impairment, lymphedema also significantly jeopardizes the patients' quality of life. 10,11 Once it becomes clinically evident, lymphedema responds poorly to treatment and tends to worsen progressively, causing irreversible fibrotic changes of the tissue. 12 Moreover, erysipelas episodes frequently complicate chronic extremity lymphedema.…”

Supermicrosurgical deep lymphatic vessel‐to‐venous anastomosis for a breast cancer‐related arm lymphedema with severe sclerosis of superficial lymphatic vessels

“…To our knowledge, this is the first report of supermicrosurgical D‐LVA. Some authors reported deep lympho‐venous bypass, but they use lymphatic vessels in deep fat layer that are lymphatic vessels of a superficial lymph system . Deep lymphatic vessels as we used in this case are lymphatic vessels of a deep lymph system that exist below the deep fascia.…”