BackgroundThe management of lymphatic vesicles is challenging. This study aimed to clarify the lymphatic flow around the genitals and the effect of genital LVA on genital lymphatic vesicles. MethodsWe performed a retrospective study of 34 patients who underwent resection for lymphatic vesicle and LVA. In patients with genital lymphedema, two types of lymphatic inflow existed around the genital area; from the lower extremities (type 1) and from the buttocks (type 2). Lymphoscintigraphy was performed to detect type 1 lymphatics injecting isotope into the first interdigital area. ICG lymphography was performed to detect type 2 lymphatics injecting ICG into the ischial tuberosity. We performed resection of lymphatic vesicles and LVA in the legs and/or in the genitals. Postoperative recurrence rate of lymphatic vesicles and the frequency of cellulitis were evaluated. ResultsType 1 lymphatics were observed in 38.2% of the patients. In ICG lymphography, there was linear inflow to the genitals in 40.9% and DB inflow in 24.2%. In 10 patients (29.4%), both type 1 and 2 lymphatic vessels were observed. Genital LVA was performed in 31 patients and lower extremity LVA was performed in 15 patients. The average follow-up period was 332 days, and recurrence was observed in 8 (25.8%) of 31 patients who underwent total resection. The average number of cellulitis episodes decreased significantly from 2.8 times before surgery to 0.31 times after surgery (p<0.01). ConclusionLVA in the genital area and lower limbs was effective in preventing postoperative recurrence of lymphatic vesicles after resection.