Filariasis

Filariasis is a tropical disease commonly found in India that affects the body’s lymphatic system. It is caused by an infection from the filarial parasite, Wuchereria bancrofti, transmitted to humans through mosquito bites. Unfortunately, this disease is often neglected by those who suffer from it.

It is often neglected by the people suffering from it.

The lymphatics of the legs and genitalia get blocked after the infection leading to the accumulation of fluid and swelling in the legs and genitalia.

It causes Lymphoedema , and swelling of the leg and genitalia due to blockage of lymphatics of the lower limb and genitalia. It is usually acquired in childhood which manifests later in life and can lead to permanent disability.

When lymphatic filariasis is left untreated, it can progress to elephantiasis—a condition characterized by the enlargement and hardening of body parts. This advanced stage is particularly challenging and can lead to severe psychological embarrassment for affected individuals.

Elephantiasis of the legs and scrotum is a significant concern in India, especially for those who suffer from it. The unsightly appearance and associated social discrimination and ostracization pose grave challenges for affected individuals.

Men live through their whole lives with this condition without any treatment and have often faced social discrimination and boycotts.

• Swelling of leg and/or scrotum not attributed to any other cause.
• The feeling of fullness or heaviness.
• Itching and Burning sensation.

• Recurrent infections /oozing of fluid out from the skin of the affected part
• No clothes fitting the part or legs
• Thick skin, deformed part leading to elephantiasis.
• Deformed penis and scrotum
• Urinary problems, retention, and infections
• Unable to have sex.

• Physical examination and history give a clue about the diagnosis.
• A radioactive dye is injected into the lymphatics and then scanned by a probe to know and delineate the flow of lymph through the lymphatic vessels to diagnose the obstruction of lymphatics.
• MRI of the part.

• Medicines specific for infection for 21 days.
• Compression therapy.
• Limb elevation.
• Massage therapy and exercises.
• Preventing infection.

If the patient seeks treatment in the initial phases of the lymphoedema before the limb is deformed, then a microsurgical approach can be adopted.

1. Free vascularized lymph node transfer: Superficial lymph nodes are harvested from the neck region with an artery and vein and microsurgically anastomosed to a recipient artery and vein after tissue release in the ankle region.

• Advantage of recruitment of healthy vascularized tissue
• Challenging and technically demanding procedure
• Post-op period with initial rigorous monitoring and maintenance of position by the patient.
• Subjective improvement was reported by 100% of patients with 78% being able to discontinue compression therapy.

2. Lympho-venous bypass: We rarely get patients suitable for this procedure. In this procedure, the blocked lymphatics are connected to the veins.

• Super-microsurgical technique to anastomose distal subdermal lymphatic vessels and adjacent venules <0.8mm.
• Minimally invasive, minimal pain, discharged within 24 hours.
• Challenging and technically demanding procedure.

If the leg is severely deformed by elephantiasis or is in an advanced stage of lymphoedema, then debulking procedures will help in reducing the severity of the disease.

• Modified Charles procedure = Excisional debulking of the deformed skin and tissues and covering the defect by skin graft. VAC therapy is given for 5 to 7 days after the surgery to ensure graft uptake.
• Homan procedure staged longitudinal excision of skin and subcutaneous tissue medially and laterally in 2 separate stages with layered closure.

• a) Alternate day dressing with IV antibiotics and limb elevation for about 2 weeks with
• b) Crepe bandage application and suture removal after about 2 weeks.
• c) Gradually the patient is mobilized with pressure garment application and massage therapy.
• d) Patients are educated about therapeutic exercises and skin care.

Elephantiasis of the genitals is a matter of great concern for all men who have it. It causes severe psychological embarrassment to men due to its unsightly appearance.

Men live through their whole lives with this condition without any treatment and have often faced social discrimination and boycotts.

They suffer a lot of issues because of this disease-

• Deformed penis and scrotum.
• Urinary problems, retention, and infections.
• Unable to have sex.

They often seek medical help when the penis and scrotum is already deformed. Most of the patients are too shy and even embarrassed to discuss with the doctors.

Dr Amit Agarwal specializes in the treatment of elephantiasis of genitals and has helped hundreds of men to lead happy and productive lives. He has devised his own technique of reduction or debulking procedure for such deformed genitals. Men are able to return to their normal lives with minimum complications after this surgery.

Patients are kept in the hospital for a minimum of 5 days and regular dressings are done on alternate days. Sutures are removed in 14 days.