Lymphaticovenular anastomosis for lymph vessel injury in the pelvis and groin

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.

Effectiveness of Supramicrosurgical Lymphatico-venular Anastomosis in Treating Recurrent Lymphatic Fistulas: A Case Series

“…Kobayashi et al suggested LVA to be a minimally invasive alternative to myocutaneous flaps for the treatment of wound complications caused by lymphedema and lymphorrhea after surgery for soft-tissue sarcomas in the adductor compartment of the thigh 16) . Regarding lower limb lympatic disorders, Katoda et al recommended LVA for the treatment of lymphatic diseases due to lymph vessel injuries in the pelvis and groin 17) .…”

Lymphaticovenular Anastomosis for Lymphorrhea after Expander-based Breast Reconstruction: A Case Report

“…1,6,7 However, as described by Giacalone et al and Kadota et al, such procedures are likely to induce subsequent lymphedema due to the obstruction of lymphatic vessels. 3,4 The best treatment would be to directly repair the damaged lymphatic vessels in the axilla by anastomosing them with intact lymphatic vessels. 2 However, because our patient had already undergone TE implantation and PMRT, it was expected to be difficult to find, dissect, and anastomose the lymphatic vessels through a chest skin incision.…”

“…After the postoperative day 2 puncture, no seroma accumulation was observed, which is compatible with previous reports noting the time required from LVA to resolution of lymphorrhea. 2,4 It is also possible that the lymphatic leakage was resolved due to radiotherapy, but recurrent seroma was observed after the puncture near the end of PMRT, suggesting again that LVA likely contributed to the resolution of lymphorrhea.…”

“…1 Lymphaticovenular anastomosis (LVA) is a standard technique for the treatment of secondary lymphedema, and recent reports have demonstrated that LVA was effective for lymphatic cysts and leakage in the inguinal and pelvic regions. [2][3][4] Yet, only a few reports have touched on the efficacy of LVA for axillary lymphorrhea. 3,5 This report presents our experience with LVA for refractory axillary lymphorrhea in postoperative breast cancer.…”

Schlieren Phenomenon for Identification of Lymphorrhea Point

“… 5 , 6 The best treatment for injured lymph vessels may be direct repair; however, it is difficult to find damaged lymph vessels in a previously treated and scarred wound. 8 In addition, lymphatic fluid is colorless and transparent, making intraoperative exact identification of lymphatic leak points difficult. So that treatment often fails, and additional treatments such as lymphaticovenular anastomosis are then often administered.…”