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Inguinal Node Dissection
Inguinal Node Dissection (Uniteral/Bilateral)
- What is Inguinal Node Dissection (Uniteral/Bilateral)
- Effects of Inguinal Node Dissection (Uniteral/Bilateral)
- Candidates for Inguinal Node Dissection (Uniteral/Bilateral)
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- The Inguinal Node Dissection (Uniteral/Bilateral) Procedure
What is Inguinal Node Dissection (Uniteral/Bilateral)?
Inguinal lymphadenectomy is commonly performed for treatment of metastases from penile carcinoma. This involves removal of the lymph nodes in the groin. This operation is used for men with penile cancer who have palpable masses in their groins after taking 6 weeks of antibiotics.
Effects of Inguinal Node Dissection (Uniteral/Bilateral)
Lymph node dissection is the most effective means of eradicating minimal lymphatic disease and of accurately staging the disease.
Candidates for Inguinal Node Dissection (Uniteral/Bilateral)
Carcinoma of the penis accounts for less than 1% of all malignancies in male patients. For the majority of patients, surgical excision is the most effective means of controlling the local penile tumor.
After a comprehensive medical history has been obtained, the patient should be thoroughly clinically examined, including the site of the primary tumor. For examination of the inguinal nodes, the patient should be positioned supine and appropriately exposed from umbilicus to the mid thigh. Both femoral triangles should be systematically palpated firmly but gently, to detect any underlying lymphadenopathy; the affected lymph nodes often have a firm, bean-like consistency.
The Inguinal Node Dissection (Uniteral/Bilateral) Procedure
If the inguinal lymph nodes are enlarged at presentation, a course of antibiotics should be given with the intention that inflammatory changes will resolve. The inguinal nodes are reassessed four to six weeks later by clinical palpation which has been noted to be practical and acceptably accurate. By then the pathological stage and grade would have been known also and this information may help in deciding on further surgery.
Whether the palpable nodes are unilateral or bilateral, it is advocated that a bilateral lympadenectomy be done due to the fact that 50 % of the lymphatics have cross-over drainage. The radical lymphadenectomy entails the removal of both the superficial and deep inguinal lymphatic chains.
No robust evidence exists for the optimal period for maintaining post-operative suction drainage. Some authorities advocate early drain removal at 24 hours after surgery, whereas others recommend removal once drainage falls beneath a specific threshold (30-50 ml over 24 hours)-which may take some weeks. Early ambulation is encouraged to minimize the risk of deep vein thrombosis, although mobilization accelerates lymph flow from the lower extremity and may augment lymph drainage. Patients are unlikely to be fit to drive for at least four to six weeks after surgery.
Complications include lymphocoele, substantial lower limb lymphedema, skin loss, and infection.
Although rarely fatal, postoperative complications after inguinal surgery are extremely debilitating and harbour considerable socioeconomic costs. Wound infection or dehiscence is more likely in elderly or obese patients. In addition, smoking, poor nutrition, and treatment with immunosuppressant drugs represent independent risk factors for impaired wound healing.
What are inguinal nodes?
The inguinal nodes are divided into two groups, superficial and deep. The superficial nodes are located beneath the subcutaneous fascia and above the fascia lata covering the muscles of the upper leg; 8 to 25 superficial nodes are present. The deep inguinal nodes are those around the fossa ovalis, the opening in the fascia lata where the saphenous vein drains into the femoral vein; 3 to 5 deep nodes are present. These nodes form the link to the second-line regional nodes, ie, the pelvic nodes. The deep nodes receive their afferents from the superficial ones and directly from the deeper structures of the penis.
What are the common complications to this procedure?
Other common complications include seroma formation (a collection of serous tissue fluid), development of lymphocele (a collection of lymphatic fluid), and lymphoedema of the lower limb. Wound cellulitis requiring readmission for treatment with intravenous antibiotics is not uncommon, and occasionally an abscess requires drainage under general anesthesia.