Lymphatic filariasis elimination depends on a two-armed approach: mass drug administration every year for not less than five years, and the morbidity management of the disease. The morbidity management of the disease has to do with the accurate diagnosis and management of filarial hydrocele and lymphoedema of the genitals and the limbs.

Diagnosis of filarial hydrocele is very vital, based on very good physical examination, transillumination and ultrasonographic examination of the scrotal swelling. This is very important because it differentiates it from other differential diagnosis like hernias and epididymo-orchitis, etc., for which management principles are different. Diagnosis of lymphoedema also depends on careful examination of the lesion and accurate staging to assist in appropriate management.

Management of filarial hydrocele has been done with dissection of the filarial hydrocele, drainage of the fluid and eversion or the total resection of the tunica vaginalis followed by drainage of the scrotal cavity. But research has revealed that eversion of the tunica vaginalis leads to recurrence of the filarial hydrocele, so the recommendation is that filarial hydrocelectomy should be done by total resection of the tunica vaginalis. Research has also revealed that drainage of the scrotal cavity post surgery leads to high rates of infection and as such the recommendation is for surgery to be done without drainage of the scrotal cavity and the need for antibiotic cover post operative. Lymphoedema for some time now has been managed with hygiene treatment and surgery but research has revealed that limb lymphoedema should only be treated with hygiene without surgery and genital lymphoedema is better managed with hygiene and reconstructive surgery.

Important complications of filarial hydrocelectomy include haematoma, infection, haemorrhage and recurrence. As a result it is recommended that surgery should be conducted meticulously with careful haemostasis and careful follow up with antibiotic cover. Cases of long standing filariasis could lead to necrosis of the testis and this will warrant the need for orchidectomy. Benefits of filarial hydrocelectomy include improved quality of life and ability to actively engage in gainful employment once again. Lymphoedema could also be complicated with acute attacks and as such needs careful follow up and antibiotic cover to reduce acute attacks and as such reduce progress in the stage of the disease. This article collection will thus highlight techniques of filarial hydrocele surgery, management principles of lymphoedema, modes of diagnosis and follow up of cases.

The following subtopics are particularly welcome:

- Type of anaesthesia required for filarial hydrocelectomy
- Types of antibiotic cover appropriate for postop management of cases
- How long cases can be followed up to prove cases of recurrence
- Kit availability in facilities for easy diagnosis and management of filarial hydrocele and lymphoedema
- The appropriate use of simulators in the training of surgeons in filarial hydrocelectomy in endemic countries

Submit your idea

Impact

Frontiers in Tropical Diseases

Submit your idea

Impact