Male genital lymphedema (MGL) is a debilitating condition that may require surgical intervention. Lymphaticovenous anastomosis (LVA) can be ineffective in primary and advanced cases because of lymphatic disruption, whereas vascularized lymph node transfer (VLNT) can overcome this limitation by promoting neolymphangiogenesis but traditionally carries some risk of donor site complications. Gastroepiploic vascularized lymph node transfer (GEVLNT) has recently emerged as an effective treatment option for upper and lower limb lymphedema, with negligible complications. However, its role in genital lymphedema remains unexplored. This is the first short series reporting the use of GEVLNT in MGL. Three male patients (44, 61, and 52 years old) with GL underwent GEVLNT. The first patient had idiopathic disease, which relapsed after previous treatment with LVA; the other two had secondary lymphedema due to cancer treatment and hydrocele surgery, respectively. In all patients, the right gastroepiploic lymphosome was harvested laparoscopically, with flap sizes of 14 × 5 cm, 15 × 4 cm, and 12 × 4 cm, respectively. The recipient vessels were the deep inferior epigastric artery and vein in the first case, and the superficial external pudendal vessels in the other two. Post-operative courses were uneventful for all patients, with no complications reported. Follow-up periods were 36, 23, and 12 months, respectively. In all cases, GEVLNT resulted in significant clinical improvements and reductions in genital lymphedema severity (GLS) scores (7-1, 9-4, and 8-4). Our preliminary experience suggests that GEVLNT could be a viable and effective option for treating male genital lymphedema with minimal donor site morbidity and stable results over time. However, further research with larger patient cohorts, comparative studies, and long-term follow-up is needed to fully establish its efficacy.

Centre for Plastic and Hand Surgery University Hospital in Ostrava Ostrava Czech Republic

Department of Nuclear Medicine and Molecular Imaging Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland

Department of Plastic and Hand Surgery Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland

Department of Plastic and Reconstructive Surgery Policlinico di Bari University of Bari Aldo Moro Bari Italy

Department of Visceral Surgery Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland

Operative Research Unit of Plastic Reconstructive and Aesthetic Surgery Fondazione Policlinico Universitario Campus Bio Medico Rome Italy

Zobrazit více v PubMed

Abdelfattah, U., T. Elbanoby, W. Ayad, M. Elshamy, and E. Allam. 2020. “Treatment of Secondary Scrotal and Lower Extremity Lymphedema Using Combined Pedicled Lymph Node Transfer and Lymphaticovenous Anastomosis: A Case Report.” Microsurgery 40, no. 8: 901–905. https://doi.org/10.1002/micr.30656.

Althubaiti, G. A., M. A. Crosby, and D. W. Chang. 2013. “Vascularized Supraclavicular Lymph Node Transfer for Lower Extremity Lymphedema Treatment.” Plastic and Reconstructive Surgery 131, no. 1: 133e–135e. https://doi.org/10.1097/PRS.0b013e318272a1b4.

Aulia, I., and E. C. Yessica. 2020. “Surgical Management of Male Genital Lymphedema: A Systematic Review.” Archives of Plastic Surgery 47, no. 1: 3–8. https://doi.org/10.5999/aps.2019.01123.

Braizat, O., S. Jarrar, M. El‐Debs, et al. 2024. “Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb: A Systematic Review and Meta‐Analysis of Clinical Outcomes.” Annals of Plastic Surgery 93, no. 1: 130–138. https://doi.org/10.1097/SAP.0000000000003918.

Brown, S., B. J. Mehrara, M. Coriddi, L. McGrath, M. Cavalli, and J. H. Dayan. 2022. “A Prospective Study on the Safety and Efficacy of Vascularized Lymph Node Transplant.” Annals of Surgery 276, no. 4: 635–653. https://doi.org/10.1097/SLA.0000000000005591.

Brunetti, B., V. Petrucci, S. Tenna, et al. 2024. “Extra‐Anatomical Pedicle Rerouting an Alternative Technique to Obtain New Recipient Vessels for Microsurgical Reconstruction in Unfavorable Clinical Situations.” Journal of Plastic, Reconstructive & Aesthetic Surgery 91: 227–235. https://doi.org/10.1016/j.bjps.2024.01.055.

Cheng, M. H., S. C. Chen, S. L. Henry, B. K. Tan, M. Chia‐Yu Lin, and J. J. Huang. 2013. “Vascularized Groin Lymph Node Flap Transfer for Postmastectomy Upper Limb Lymphedema: Flap Anatomy, Recipient Sites, and Outcomes.” Plastic and Reconstructive Surgery 131, no. 6: 1286–1298. https://doi.org/10.1097/PRS.0b013e31828bd3b3.

Cheng, M. H., J. J. Huang, D. H. Nguyen, et al. 2012. “A Novel Approach to the Treatment of Lower Extremity Lymphedema by Transferring a Vascularized Submental Lymph Node Flap to the Ankle.” Gynecologic Oncology 126, no. 1: 93–98. https://doi.org/10.1016/j.ygyno.2012.04.017.

Ciudad, P., M. Maruccia, J. Socas, et al. 2017. “The Laparoscopic Right Gastroepiploic Lymph Node Flap Transfer for Upper and Lower Limb Lymphedema: Technique and Outcomes.” Microsurgery 37, no. 3: 197–205. https://doi.org/10.1002/micr.22450.

Ciudad, P., M. D. Sabbagh, M. Agko, et al. 2019. “Surgical Management of Lower Extremity Lymphedema: A Comprehensive Review.” Indian Journal of Plastic Surgery 52, no. 1: 81–92. https://doi.org/10.1055/s‐0039‐1688537.

Coroneos, C. J., M. Asaad, F. C. Wong, et al. 2022. “Outcomes and Technical Modifications of Vascularized Lymph Node Transplantation From the Lateral Thoracic Region for Treatment of Lymphedema.” Journal of Surgical Oncology 125, no. 4: 603–614. https://doi.org/10.1002/jso.26783.

Das, S., D. Tuerk, A. D. Amar, and J. Sommer. 1983. “Surgery of Male Genital Lymphedema.” Journal of Urology 129, no. 6: 1240–1242. https://doi.org/10.1016/s0022‐5347(17)52662‐2.

Deptula, P., A. Zhou, V. Posternak, H. He, and D. Nguyen. 2022. “Multimodality Approach to Lymphedema Surgery Achieves and Maintains Normal Limb Volumes: A Treatment Algorithm to Optimize Outcomes.” Journal of Clinical Medicine 11, no. 3: 598. https://doi.org/10.3390/jcm11030598.

di Summa, P. G., M. Guiotto, P. Zaugg, et al. 2019. “Multiple Lymphatic‐Venous Anastomoses (MLVA) for Microsurgical Drainage of Primary Peno‐Scrotal Lymphedema: A Case Report.” Lymphology 52, no. 3: 149–154. https://doi.org/10.2458/lymph.4636.

Dianzani, C., F. Gaspardini, P. Persichetti, et al. 2010. “Giant Scrotal Elephantiasis: An Idiopathic Case.” International Journal of Immunopathology and Pharmacology 23, no. 1: 369–372. https://doi.org/10.1177/039463201002300138.

Elia, R., H. C. Chen, G. Cazzato, P. G. Di Summa, G. Giudice, and M. Maruccia. 2024. “Evaluation of Modulation of Immunity by Lymph Node Transfer: A Preliminary Histological Evidence in Lymphedema Patients.” Microsurgery 44, no. 1: e31123. https://doi.org/10.1002/micr.31123.

Garaffa, G., N. Christopher, and D. J. Ralph. 2008. “The Management of Genital Lymphoedema.” BJU International 102, no. 4: 480–484. https://doi.org/10.1111/j.1464‐410X.2008.07559.x.

Gould, D. J., B. J. Mehrara, P. Neligan, M. H. Cheng, and K. M. Patel. 2018. “Lymph Node Transplantation for the Treatment of Lymphedema.” Journal of Surgical Oncology 118, no. 5: 736–742. https://doi.org/10.1002/jso.25180.

Grünherz, L., C. Barbon, D. von Reibnitz, et al. 2024. “Analysis of Different Outcome Parameters and Quality of Life After Different Techniques of Free Vascularized Lymph Node Transfer.” Journal of Vascular Surgery. Venous and Lymphatic Disorders 12: 101934. https://doi.org/10.1016/j.jvsv.2024.101934.

Guiotto, M., R. J. Bramhall, C. Campisi, W. Raffoul, and P. G. di Summa. 2019. “A Systematic Review of Outcomes After Genital Lymphedema Surgery: Microsurgical Reconstruction Versus Excisional Procedures.” Annals of Plastic Surgery 83, no. 6: e85–e91. https://doi.org/10.1097/SAP.0000000000001875.

Howell, A. C., D. J. Gould, C. Mayfield, K. Samakar, C. Hassani, and K. M. Patel. 2018. “Anatomical Basis of the Gastroepiploic Vascularized Lymph Node Transfer: A Radiographic Evaluation Using Computed Tomographic Angiography.” Plastic and Reconstructive Surgery 142, no. 4: 1046–1052. https://doi.org/10.1097/PRS.0000000000004772.

Jian, Y., C. Deng, and Z. Wei. 2023. “Research Progress of Combined Surgical Treatment of Lymphedema Based on Vascularized Lymph Node Transfer.” Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 37, no. 2: 240–246. https://doi.org/10.7507/1002‐1892.202210009.

Kaciulyte, J., L. Garutti, D. Spadoni, et al. 2021. “Genital Lymphedema and How to Deal With It: Pearls and Pitfalls From Over 38 Years of Experience With Unusual Lymphatic System Impairment.” Medicina 57, no. 11: 1175. https://doi.org/10.3390/medicina57111175.

Kung, T. A., M. C. Champaneria, J. H. Maki, and P. C. Neligan. 2017. “Current Concepts in the Surgical Management of Lymphedema.” Plastic and Reconstructive Surgery 139, no. 4: 1003e–1013e. https://doi.org/10.1097/PRS.0000000000003218.

Li, Y., R. Dong, Z. Li, L. Wang, and X. Long. 2021. “Intra‐Abdominal Vascularized Lymph Node Transfer for Treatment of Lymphedema: A Systematic Literature Review and Meta‐Analysis.” Microsurgery 41, no. 8: 802–815. https://doi.org/10.1002/micr.30812.

Liebermann‐Meffert, D. 2000. “The Greater Omentum. Anatomy, Embryology, and Surgical Applications.” Surgical Clinics of North America 80, no. 1: 275. https://doi.org/10.1016/s0039‐6109(05)70406‐0.

Manrique, O. J., S. S. Bustos, T. Kapoor, et al. 2020. “Gastroepiploic Vascularized Lymph Node Transfer for the Treatment of Extremity Lymphedema: Comparison Between Middle and Distal Inset.” Gland Surgery 9, no. 2: 528–538. https://doi.org/10.21037/gs.2020.02.10.

Maruccia, M., G. Giudice, P. Ciudad, et al. 2023. “Lymph Node Transfer and Neolymphangiogenesis: From Theory to Evidence.” Plastic and Reconstructive Surgery 152, no. 5: 904e–912e. https://doi.org/10.1097/PRS.0000000000010434.

Meza‐Perez, S., and T. D. Randall. 2017. “Immunological Functions of the Omentum.” Trends in Immunology 38, no. 7: 526–536. https://doi.org/10.1016/j.it.2017.03.002.

Modolin, M., A. I. Mitre, J. C. da Silva, et al. 2006. “Surgical Treatment of Lymphedema of the Penis and Scrotum.” Clinics 61, no. 4: 289–294. https://doi.org/10.1590/s1807‐59322006000400003.

Mukenge, S., D. Negrini, M. Catena, et al. 2013. “Development of Functionally Patent Lymphatic Meshes in Postsurgical Long‐Term Resolution of Peripheral Secondary Lymphedema.” Journal of Vascular Surgery. Venous and Lymphatic Disorders 1, no. 3: 280–288. https://doi.org/10.1016/j.jvsv.2012.09.008.

Mukenge, S., C. Pulitanò, R. Colombo, D. Negrini, and G. Ferla. 2007. “Secondary Scrotal Lymphedema: A Novel Microsurgical Approach.” Microsurgery 27, no. 8: 655–656. https://doi.org/10.1002/micr.20426.

Nguyen, A. T., and H. Suami. 2015. “Laparoscopic Free Omental Lymphatic Flap for the Treatment of Lymphedema.” Plastic and Reconstructive Surgery 136, no. 1: 114–118. https://doi.org/10.1097/PRS.0000000000001374.

Nguyen, A. T., H. Suami, M. M. Hanasono, V. A. Womack, F. C. Wong, and E. I. Chang. 2017. “Long‐Term Outcomes of the Minimally Invasive Free Vascularized Omental Lymphatic Flap for the Treatment of Lymphedema.” Journal of Surgical Oncology 115, no. 1: 84–89. https://doi.org/10.1002/jso.24379.

O'Brien, B. M., C. G. Mellow, R. K. Khazanchi, E. Dvir, V. Kumar, and W. C. Pederson. 1990. “Long‐Term Results After Microlymphaticovenous Anastomoses for the Treatment of Obstructive Lymphedema.” Plastic and Reconstructive Surgery 85, no. 4: 562–572. https://doi.org/10.1097/00006534‐199004000‐00011.

Phan, R., M. A. Seifman, R. Dhillon, P. Lim, D. J. Hunter‐Smith, and W. M. Rozen. 2020. “Use of Submental and Submandibular Free Vascularized Lymph Node Transfer for Treatment of Scrotal Lymphedema: Report of Two Cases.” Microsurgery 40, no. 7: 808–813. https://doi.org/10.1002/micr.30651.

Pons, G., J. Masia, P. Loschi, M. L. Nardulli, and J. Duch. 2014. “A Case of Donor‐Site Lymphoedema After Lymph Node‐Superficial Circumflex Iliac Artery Perforator Flap Transfer.” Journal of Plastic, Reconstructive & Aesthetic Surgery 67, no. 1: 119–123. https://doi.org/10.1016/j.bjps.2013.06.005.

Scaglioni, M. F., M. Arvanitakis, Y. C. Chen, P. Giovanoli, J. Chia‐Shen Yang, and E. I. Chang. 2018. “Comprehensive Review of Vascularized Lymph Node Transfers for Lymphedema: Outcomes and Complications.” Microsurgery 38, no. 2: 222–229. https://doi.org/10.1002/micr.30079.

Scaglioni, M. F., M. Meroni, and E. Fritsche. 2020. “Lymphovenous Anastomosis (LVA) for Treatment of Isolated Penile Lymphedema: A Case Report.” Microsurgery 40, no. 6: 692–695. https://doi.org/10.1002/micr.30560.

Schook, C. C., A. M. Kulungowski, A. K. Greene, and S. J. Fishman. 2014. “Male Genital Lymphedema: Clinical Features and Management in 25 Pediatric Patients.” Journal of Pediatric Surgery 49, no. 11: 1647–1651. https://doi.org/10.1016/j.jpedsurg.2014.05.031.

Torio‐Padron, N., G. B. Stark, E. Földi, and F. Simunovic. 2015. “Treatment of Male Genital Lymphedema: An Integrated Concept.” Journal of Plastic, Reconstructive & Aesthetic Surgery 68, no. 2: 262–268. https://doi.org/10.1016/j.bjps.2014.10.003.

Vignes, S., M. Blanchard, A. Yannoutsos, and M. Arrault. 2013. “Complications of Autologous Lymph‐Node Transplantation for Limb Lymphoedema.” European Journal of Vascular and Endovascular Surgery 45, no. 5: 516–520. https://doi.org/10.1016/j.ejvs.2012.11.026.

Yamamoto, T., B. W. Daniel, J. R. Rodriguez, et al. 2022. “Radical Reduction and Reconstruction for Male Genital Elephantiasis: Superficial Circumflex Iliac Artery Perforator (SCIP) Lymphatic Flap Transfer After Elephantiasis Tissue Resection.” Journal of Plastic, Reconstructive & Aesthetic Surgery 75, no. 2: 870–880. https://doi.org/10.1016/j.bjps.2021.08.011.

Yamamoto, T., I. Koshima, H. Yoshimatsu, M. Narushima, M. Miahara, and T. Iida. 2011. “Simultaneous Multi‐Site Lymphaticovenular Anastomoses for Primary Lower Extremity and Genital Lymphoedema Complicated With Severe Lymphorrhea.” Journal of Plastic, Reconstructive & Aesthetic Surgery 64, no. 6: 812–815. https://doi.org/10.1016/j.bjps.2010.10.011.

Yamamoto, T., N. Yamamoto, M. Furuya, A. Hayashi, and I. Koshima. 2016. “Genital Lymphedema Score: Genital Lymphedema Severity Scoring System Based on Subjective Symptoms.” Annals of Plastic Surgery 77, no. 1: 119–121. https://doi.org/10.1097/SAP.0000000000000360.