Simultaneous multi-site lymphaticovenular anastomoses for primary lower extremity and genital lymphoedema complicated with severe lymphorrhea.

Primary lower extremity and genital lymphoedema (GL) is difficult to manage, especially when complicated with severe lymphorrhea. With abundant experience of treatment for lower-extremity lymphoedema (LEL), we performed simultaneous multi-site lymphaticovenular anastomoses (LVAs) for GL with severe lymphorrhea. In two cases of primary LEL and GL, LVAs were performed via 2-cm-long skin incisions using two to three operating microscopes under local anaesthesia. Symptoms of oedema and lymphorrhea improved clinically. LVA is a minimally invasive surgery, which is effective for the treatment of LEL and GL even in primary cases with severe lymphorrhea. Simultaneous multi-site LVAs can serve as the most effective therapy for lymphoedema.