BACKGROUND
Medial thigh lift in patients after bariatric surgery may injure lymphatic channels and cause lymphatic complications, including lymphocele and secondary lymphedema. Most lymphoceles resolve with conservative treatment, but chronic high-output collections associated with lymphatic drainage impairment remain difficult to manage and lack a standardized strategy.
CASE REPORT
After bariatric surgery, a 51-year-old woman developed a chronic encapsulated fluid collection of the left medial thigh after medial thigh lift, associated with secondary lymphedema. Magnetic resonance imaging (MRI) showed a collection measuring 28×7×9 cm, and lymphoscintigraphy demonstrated impaired lymphatic drainage. Serial aspirations every 3 days evacuated 0.5 to 1.0 L of clear fluid per session, with rapid recurrence. Surgery consisted of complete capsulectomy and targeted ligation of the leakage point guided by intraoperative indocyanine green and methylene blue mapping. Two distal lymphaticovenular anastomoses were performed below the knee with 11-0 nylon to restore lymphatic outflow. Negative pressure wound therapy with instillation was applied for 5 days to collapse the dead space and control output, followed by definitive closure over suction drainage. At 12 months, limb circumferences normalized, and MRI confirmed resolution of the lymphocele with stable reduction of lymphedema. At 24 months, no recurrence or complications were observed.
CONCLUSIONS
Combined capsulectomy, leak ligation, distal lymphaticovenular anastomoses, and negative pressure wound therapy with instillation may represent a useful option for refractory lymphocele associated with secondary lymphedema after medial thigh lift. This approach addresses both cavity control and lymphatic drainage impairment. Additional cases are needed to define reproducibility and indications.

Keywords: Anastomosis, Surgical; Bariatric Surgery; Indocyanine Green; Lymphocele; Negative-Pressure Wound Therapy