Introduction: Adverse  reactions  following  BCG  vaccination  are  uncommon,   with  an estimated prevalence of 0.4 per 1000 vaccines. The options for surgical management  of post BCG vaccine suppurative lymphadenitis  are incision  and drainage, total excision, or simple needle aspiration. The aim of the study is to compare the outcome of surgical treatment of suppurative post BCG lymphadenitis using simple needle aspiration versus primary excision. Patients and methods: A retrospective file review was done for all children who presented, with a diagnosis of post BCG vaccine suppurative lymphadenitis (axillary and/ or supraclavicular), to the pediatric surgery clinic in two tertiary pediatric surgery  centers during the period from January 2007 to January 2013. Results:  The study population included 91 patients, 38 in Group 1 versus 53 in Group 2. There were 60 males and 31 females. Two groups  were identified in the  study, according to the type of management  at the initial presentation, Group 1 who were managed with simple needle aspiration and Group 2 who were managed with primary surgical excision. Patients who received antituberculous treatment were excluded from the study. Conclusion: Primary  surgical excision  for post BCG  suppurative  lymphadenitis  showed better outcomes than needle aspiration in the current study population.