Duchenne's operation is the removal of superficial and deep lymph nodes of the inguinal-femoral region as a single block with subcutaneous tissue, a section of the broad fascia of the femur and resection of the large saphenous vein.
This name was given to the surgical intervention on behalf of the French surgeon, who in 1934 first applied this method. It happened almost 80 years ago. Modern oncologist surgeons perform this operation with more gentle methods thanks to the latest technologies and equipment. The operations of Duchenne, Melnikov and other prominent doctors have made a great contribution to the development of modern surgery.
Indications
This method of therapy can be prescribed in the case of the development of a malignant tumor in the genitals, when the disease has reached the stage at which metastases in the lymph nodes appear. Do not assume that surgical intervention is not necessary if, upon palpation, the lymph nodes remain in their natural state. Duchenne’s operation is also necessary in this case. It is prescribed for cancer of the vulva, scrotum, penis, body parts in the anus.
In addition, indications for Duchenne surgery are:
- The need to prevent the progressive spread of metastases to other internal organs. It is prescribed even for small-sized malignant tumors on the genitals.
- If it is not possible by other methods to examine the tumor for the presence of metastases, Duchenne surgery may be prescribed.
- If after the diagnosis of a cancerous tumor in the genital area, enlarged lymph nodes were detected.
The need for surgical treatment for lesions of the inguinal-femoral and iliac lymph nodes with metastases
During surgical treatment procedures in oncology, it is always necessary to remove the primary neoplasm together with the regional lymphatic base.
For cancerous tumors of the external genitalia, legs, skin of the abdomen, lumbar and gluteal regions, the inguinal-femoral regions are considered regional lymph nodes, after which the process can switch to pelvic. Fight with metastatic lesions of this lymphatic collector is necessary by removing it by the fascial-sheath method in the area of subcutaneous adipose tissue with the lymph nodes located in it.
If we talk about the preventive focus of the technique of Duchenne surgery, then everything is individual. The following points must be considered:
- The immediate proximity of the primary tumor and inguinal lymph nodes.
- The presence of a large ulcerated tumor on the leg or wide base.
- The presence of microscopic indicators of deep neoplasm invasion.
Contraindications
There are no specific contraindications to this technique. To reduce the negative consequences of Duchenne surgery, you must strictly adhere to such recommendations:
- If the main operation to remove the tumor is indicated, then the excision of the lymphatic system is carried out no later than two weeks after the initial surgical intervention.
- At the time of the operation, the stability of the patient’s condition and the absence of colds or other infectious diseases are important.
Preparation for Duchenne surgery
To give permission for surgery, the doctor must refer the patient to a full examination and make a preliminary or accurate diagnosis.
Before inguinal-femoral lymphadenectomy, the following examination is performed:
- A general and biochemical blood test is given.
- An electrocardiogram is performed.
- An allergenic test is performed.
- Blood type is determined.
A week before Duchenne surgery, you should stop taking medications with a blood-thinning effect. You also need to remove foods from the diet that can cause increased gas formation or allergic reactions. All week preceding surgery, it is advisable to eat light food (the basis of the diet should be semi-liquid dishes).
Operation progress
Since there will be extensive surgical intervention, all the actions of the doctor are carried out under general anesthesia.
Description of the Duchenne operation:
- A skin incision is initially made 3-4 cm above the ligament of the inguinal region. It is conducted along the projection of a bundle of blood vessels down to the apex of the femoral triangle (13-15 cm below the inguinal ligament).
- The skin, in conjunction with subcutaneous tissue, is separated from the outer edge of the incision to the medial region of the tailor muscle, and from the inner to the medial edge of the oblong adductor muscle.
- At the same time, thorough removal of superficial lymph nodes in the femoral region is carried out. But excessive removal of subcutaneous tissue is not done, as this causes tissue necrosis.
- After dissection of adipose tissue and fascia in the lower corner of the wound, a large saphenous vein of the thigh is determined, bandaged and crossed. The same thing is done with a large saphenous vein. After that, all incisions are sutured, the wound is drained, a wide pressure bandage is applied to the site of the surgical intervention.
Postoperative period
The recovery period lasts an average of 2-3 months, but much will depend on the patient. It is important to follow all the doctor's recommendations. They are based on the following rules:
- The limb through which access to the lymph nodes was carried out should remain in a bent position for 4-6 days.
- After the operation, a certain time must be spent in a lying position, to make all movements smoothly, without sharp jerks.
- All patient food should be thermally processed, water should be drunk in a limited amount.
- Bladder emptying should be done immediately after the first urge.
- If constipation has developed, it is permissible to take a mild laxative.
- In case of complications, it is urgent to notify the attending physician about this.
Possible complications
We examined the evidence for Duchenne’s operation. The consequences of such an intervention may be different. The patient must understand the complexity of the operation and be aware that complications can develop even with a favorable outcome of the intervention. Therefore, do not violate the rules prescribed by the doctor during the rehabilitation period.
Complications can occur with the following consequences:
- Swelling at the surgical site.
- Even after drainage, lymph can accumulate.
- The presence of subcutaneous hematomas.
- Tears of thin capillaries (usually they arise due to sudden movements of the patient).
- Suppuration at the site of removal of the lymph nodes.
- At the site of tissue excision, circulatory disturbance is possible.
- Violation of coordination of movement in the lower extremities.
- Soreness in the groin and legs.
Disadvantages of the method
Despite the great importance for the life of the patient, Duchenne surgery has several disadvantages:
- In the front side of the thigh and abdominal wall, circulatory disturbance most often occurs. This occurs due to a vertical section in the projection of the femoral vessels. They are located perpendicular to force skin lines.
- The vertical scar significantly limits the movement of the patient, which is manifested by pulling pains and uncomfortable sensations.
- A large longitudinal incision in 50% of cases leads to suppuration of the wound with its long healing. This can also be observed due to secondary muscle tension.
- The development of extensive marginal skin necrosis. This occurs from its insufficient nutrition due to scalping of the skin, which is necessary in order to remove lymph nodes affected by metastases.
- Postoperative exfoliation of skin flaps, and sometimes suppuration of lymphatic sagging. After the operation, cavities are formed in which lymph accumulates. Most often, its suppuration is due to the excess weight of the patient, since this indicator is found in most patients.
It is these negative points that lead to subsequent complications.
Duchenne’s operation, despite having become a classic in the surgical world, has many negative consequences. But if you follow all the doctor’s instructions, then the complications will be minor. Now the operation has been slightly modified to exclude dissemination of metastases above or below the lesion site. To do this, not only remove the lymph nodes and part of the large vein, but also carry out the separation of the deep and superficial lymphatic ducts, cross the lymph vessels in the legs below the lesion.