inguinal lymph node dissection

1. Inguinal Node Dissection
Dr G Praveen Chandra

4. Broder’s grading

8. Inguinal
anatomy

10. SLNB-
Cabanas-1977

11. DSNB

13. Ultrasound Criteria

14. Lymphoscintigraphy:
Dynamic images

15. Limits of standard and modified
groin dissection

16. Modified inguinal
lymphadenectomy-Catalona-
1988

17. Key aspects of the procedure are
(1) Shorter skin incision
(2) Limitation of the dissection by
excluding the area lateral to the
femoral artery and caudal to the
fossa ovalis
(3) Preservation of the saphenous vein
&
(4) Elimination of the need to transpose
the Sartorius muscle.

18. Right inguinal region after
modified lymphadenectomy

19. PALPABLE INGUINAL
ADENOPATHY OR
POSITIVE INGUINAL NODES

20. Radical Inguinofemoral Lymph
Node Dissection

21. Ilioinguinal
lymph node
dissection

22. Initial
dissection for
radical IFLND

23. After
saphenous-
sparing,
radical, left
IFLND

24. Packet will
remain in
continuity with
the pelvic
dissection
in the area of
the femoral
canal

25. After right radical IFLND

26. Sartorius transposition

27. Closure
 Primary closure…….usually possible
 If large area of inguinal soft tissue
sacrificed, primary closure may be
obtained by
◦ scrotal skin rotation flaps,
◦ abdominal wall advancement flap
◦ myocutaneous flap based on the rectus
abdominis or tensor fasciae latae

28. Post-op
 Bed rest for 2 or 3 days
 Pneumatic compression stockings are
used.
 Drains are removed after 5 to 7 days,
when drainage is less than 30 to 40
mL/day.
 Suppressive dose of a cephalosporin for

29. Complications
Minor ( 40-56% of
dissections )
 lymphocele,
 wound infection or
necrosis
 lymphedema
Major 4-21% of
patients
◦ Debilitating
lymphedema
◦ Flap necrosis
◦ Lymphocele req.
intervent’n
◦ DVT
◦ PE

30. Thank You