Treating and preventing recurrence of recurrent genital acquired lymphangiectasia using lymphaticovenous anastomosis at genital area: A case report.

Abstract

After the simple resection of genital acquired lymphangiectasia, a high recurrence rate is reported, as lymphatic fluid from the legs to the genital region continues. Here we report a case in which we treated and prevented recurrence of recurrent genital acquired lymphangiectasia with genital lymphaticovenous anastomosis (LVA). A 48-year-old woman underwent hysterectomy and pelvic lymph node dissection for uterine cervical cancer at 30 years of age. The patient consulted our department for lymphedema in bilateral legs and acquired lymphangiectasia in the major labia. Despite nine attempted genital acquired lymphangiectasia resections and LVA in the lower limbs, which was aimed to prevent the recurrence, it recurred within 1-2 months postoperatively. Then we injected indocyanine green (ICG) to the bilateral edge of the anus before 10th LVA. ICG flowed from the anus to the genital area and we performed acquired lymphangiectasia resection and genital LVA on this lymphatic vessel (one anastomosis). After 6 months postoperatively, no recurrence of acquired lymphangiectasia, lymphatic leakage, or cellulitis had occurred. We found that a lymphatic flow from the anus into genital acquired lymphangiectasia occurred in one of the patients and the genital LVA, anastomosis of that responsible lymphatic vessel to the vein, might prevent genital acquired lymphangiectasia recurrence after resectional treatment.