A retrospective study was done on 38 patients with atypical mycobacterial lymphadenitis who underwent surgical intervention at The Children's Hospital, Denver, between the years 1953 and 1983. One group consisting of 18 patients had incision and drainage of the abscess or biopsy only. Sixteen of these patients developed a draining sinus or recurrent disease within a few months despite the use of antituberculous drugs or antibiotics. The other group, consisting of 20 patients, were treated initially by total excision of the inflammatory mass with no persistence or recurrence. The groups were found to be comparable with respect to age, sex, race, duration of disease and size and site of the lymph node involved. We recommend total excision of the lesion without antituberculous medications as the first choice of treatment.