World Journal of Surgery

, Volume 39, Issue 12, pp 2885–2899 | Cite as

Surgical Treatment of Genital Manifestations of Lymphatic Filariasis: A Systematic Review

  • Kah Heng Alexander Lim
  • Rick Speare
  • Gail Thomas
  • Patricia Graves
Scientific Review


Genital manifestations of lymphatic filariasis (genital LF) are a significant cause of disfigurement and disability in the developing world. Surgery is the standard treatment; however, definitive publications are lacking and best practice remains unclear. An exhaustive search strategy using keyword and subject headings was applied to Medline, EMBASE, Web of Science, CINAHL, and Scopus. Additionally citation lists, Google and Google Scholar, archives of relevant journals and websites were searched systematically. Studies with data on one or more human patient(s) who underwent surgery for genital LF were included. Articles were screened and data extracted by the first author with data verification by the second author. Fifty-seven studies were included: 18 series of ablative surgery, four series of non-ablative surgery and 35 case reports. Poor study quality, heterogeneous case definitions, lack of severity grading and limited follow-up precluded meta-analysis. Two series of simple hydrocelectomies performed in resource-limited settings reported early complication rates of 3.0–3.5 % using eversion and 5–7 % using excision, with recurrence of 7 % and 3–5 %, respectively. Complications were minimal for single-surgeon series and greater (12–18 %) when scrotal reconstruction was performed. There is little useful evidence for lymphatic bypass procedures in genital LF. Under-recognition of atypical manifestation of genital LF leads to potentially unnecessary surgeries. Surgery for genital LF is safe in resource-limited settings; however, more well-designed studies with better follow-up are needed. Research priorities include validation of case definitions and severity grading systems, and solutions to improve post-operative follow-up in resource-limited settings.


Lymphedema Lymphatic Filariasis Mass Drug Administration Hydrocele Split Skin Graft 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Dr J. Yao for kindly screening Chinese articles and data extraction.

Compliance with ethical standards

Conflicts of interest

The study was a part of a Masters dissertation by KL. The adviser of the review was GT who is an author of a study included in the review. The authors have no financial conflicts of interest to declare. The research has not been submitted to another journal.


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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Kah Heng Alexander Lim
    • 1
  • Rick Speare
    • 1
  • Gail Thomas
    • 2
  • Patricia Graves
    • 1
    • 3
  1. 1.College of Public Health, Medical and Veterinary SciencesJames Cook UniversityTownsvilleAustralia
  2. 2.The Carter CenterOne CopenhillAtlantaUSA
  3. 3.JCU/WHO Collaborating Centre for LF, STH and Other NTDs, Division of Tropical Health and MedicineJames Cook UniversityCairnsAustralia

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