Surgical Treatment of Genital Manifestations of Lymphatic Filariasis: A Systematic Review.
Identifieur interne : 001795 ( Main/Curation ); précédent : 001794; suivant : 001796Surgical Treatment of Genital Manifestations of Lymphatic Filariasis: A Systematic Review.
Auteurs : Kah Heng Alexander Lim [Australie] ; Rick Speare [Australie] ; Gail Thomas [États-Unis] ; Patricia Graves [Australie]Source :
- World journal of surgery [ 1432-2323 ] ; 2015.
Descripteurs français
- KwdFr :
- MESH :
- diagnostic : Filariose lymphatique.
- épidémiologie : Filariose lymphatique.
- Adolescent, Adulte, Adulte d'âge moyen, Enfant, Femelle, Filariose lymphatique, Humains, Hydrocèle, Jeune adulte, Mâle, Pénis, Récidive, Scrotum, Sujet âgé, Vagin.
English descriptors
- KwdEn :
- MESH :
- diagnosis : Elephantiasis, Filarial.
- epidemiology : Elephantiasis, Filarial.
- surgery : Elephantiasis, Filarial, Penis, Scrotum, Testicular Hydrocele, Vagina.
- Adolescent, Adult, Aged, Child, Female, Humans, Male, Middle Aged, Recurrence, Young Adult.
Abstract
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.
DOI: 10.1007/s00268-015-3220-4
PubMed: 26319260
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pubmed:26319260Le document en format XML
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<term>Elephantiasis, Filarial (epidemiology)</term>
<term>Elephantiasis, Filarial (surgery)</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Penis (surgery)</term>
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<term>Scrotum (surgery)</term>
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<term>Young Adult</term>
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<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Enfant</term>
<term>Femelle</term>
<term>Filariose lymphatique ()</term>
<term>Filariose lymphatique (diagnostic)</term>
<term>Filariose lymphatique (épidémiologie)</term>
<term>Humains</term>
<term>Hydrocèle ()</term>
<term>Jeune adulte</term>
<term>Mâle</term>
<term>Pénis ()</term>
<term>Récidive</term>
<term>Scrotum ()</term>
<term>Sujet âgé</term>
<term>Vagin ()</term>
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<term>Penis</term>
<term>Scrotum</term>
<term>Testicular Hydrocele</term>
<term>Vagina</term>
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<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Filariose lymphatique</term>
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<term>Femelle</term>
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<term>Hydrocèle</term>
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<front><div type="abstract" xml:lang="en">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.</div>
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