Inguinal lymph node (Groin) dissection

Introduction

Groin dissection is a surgical procedure to remove lymph nodes from the groin.

What do lymph nodes do?

Lymph nodes filter bacteria and cancer cells from tissue fluid. Groups of lymph nodes are found in the neck, axilla (armpit), groin, chest and abdomen.

Does removing them cause problems?

Removal of the lymph nodes can cause a build up of fluid at the site of the wound (a seroma) or within the whole limb (lymphoedema). Loss of the lymph nodes and swelling make the leg more susceptible to infection.

Why do I need a groin dissection?

Groin dissection is performed to remove all the lymph nodes that may have cancer within them. This prevents the cancer from recurring within the groin and may stop the cancer from spreading elsewhere.

What is the technique for groin dissection?

A general anaesthetic (GA) is required. The operation takes about 3 hours plus time to have the anaesthetic. An incision is made in the groin; all the lymph nodes and surrounding fatty tissue are removed. The wound is sutured with dissolving sutures and one or two drains are left in place. The drains siphon off excess fluid and may remain for many weeks until the amount of fluid produced gradually reduces.

All the tissue that is removed is sent for analysis. These results will be available after a few weeks.

You may have a catheter (a tube that goes up the urethra into the bladder) to drain urine for the first few days.

Possible complications

More than 50% of patients will have problems with infection, wound healing or collection of fluid.

Pain
Infection – often seen by redness or increasing tenderness around the wound
Bleeding
Wound breakdown
Scar – after a few months the scar may become tight and red, this usually settles within 12-18 months. After the wound is healed, massage of the wound with a simple hypoallergenic cream will help to soften the scar and regain normal sensation.
Numbness on the front of the leg – often permanent
Seroma (collection of fluid within wound) – a drain will remove fluid initially but if the seroma persists it may require drainage via a small needle
Lymphoedema (swelling of the leg)
DVT (deep vein thrombosis) or PE (pulmonary embolism) – you will have compression stockings to wear and injections into the tummy to thin the blood
Need for another operation - often for infection or bleeding
Recurrence of cancer

After surgery & when you go home

Tiredness - you will feel rather tired after the operation and for the next few weeks. Gradually return to normal activities over 4-6 weeks.
Wound care - you may shower after 48 hours and remove the outer dressing (Nurses will assist with this). Showering is better than bathing. The tape on your wound (Micropore) should be patted dry or dried with a hair dryer on cool (to avoid burns).
Drains - are left in place until they drain less than 40 mls per day. Some times you will go home with the drains in place. Nursing staff will teach you how to look after them and district nurses will come to your house to monitor the drainage and change bottles if needed.
Seroma - If a collection of fluid (seroma) develops after the drains come out then please call my secretary for a time to have the fluid drained away. This is done by using a small needle, fortunately this area is usually has reduced sensation and is not especially painful.
Mobilization - I encourage you to get out of bed as soon as you feel able to do so – usually the day after surgery. Please allow the nursing staff to help you initially, as you may be unsteady on your feet.
Driving - you will be able to start driving when you feel that you can safely control a motor vehicle. For most people this is about 4 weeks post surgery. It is advisable to check with your insurance company before driving.
Everyday activities - you will need help at home for about 4 weeks with activities such as cooking, laundry and housework.
Long term care of leg – take extra care to avoid insect bites, scratches or other trauma to the leg. Clean any wound carefully and watch for any early signs of infection such as swelling, redness and pain. If these occur then please call your GP. Do not walk barefooted and wear comfortable shoes.

Things to worry about…

• Pain not controlled with painkillers
• Increasing redness of wound
• Profuse oozing or bleeding from wound
• High temperature (unconnected to cold or flu or another cause)
• Offensive odour from the wound dressings

Avoiding Lymphoedema

Lymphoedema is a build up of tissue fluid within the soft tissues of the leg. Symptoms include swelling, a feeling of heaviness or tightness, discomfort, dryness of skin and reduced movement.

• Clean any bites or scratches immediately to avoid infection
• Treat infection early by seeing your GP promptly for antibiotics
• Keep skin moisturised 
• Avoid weight gain
• Avoid sunburn, hot baths and saunas
• Wear comfortable shoes
• Avoid bare feet
• Discuss symptoms with us early so we can institute treatment early.