The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial

Abstract

Please cite this paper as: Dua A, Galimberti A, Subramaniam M, Popli G, Radley S. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG 2011; DOI: 10.1111/j.1471‐0528.2011.03170.x. Objective To evaluate the efficacy of vault drainage in reducing the immediate postoperative morbidity associated with vaginal hysterectomy carried out for benign gynaecological conditions. Design Randomised controlled trial. Setting A tertiary referral gynaecology centre in UK. Population A total of 272 women who underwent vaginal hysterectomy for benign conditions between March 2005 and June 2010. Methods The 272 women were randomised to have a drain inserted or not inserted, ‘drain’ or ‘no drain’, respectively, before vault closure during vaginal hysterectomy, using a sealed envelope technique. The surgical procedures were performed using the surgeons’ standard technique and postoperative care was delivered according to the unit’s protocol. Main outcome measures The primary outcome measure was reduction in postoperative febrile morbidity. Secondary outcome measures were hospital readmission rate, blood transfusion, change in postoperative haemoglobin and length of stay. Results In all, 135 women were randomised to have a drain and 137 to ‘no drain’. There were no differences in the incidence of febrile morbidity, length of stay, change in haemoglobin or need for postoperative blood transfusion between the two groups. Conclusions The routine use of vault drain at vaginal hysterectomy for benign disorders has no significant effect on postoperative morbidity. The use of vault drain in this context is not recommended.

Issues around vaginal vault closure

“…Recently, studies have shown that use of a bipolar vessel sealing system is associated with a lower risk of vault haematoma . However, no proven benefit was identified for routine vault drainage …”

Vaginal vault drainage after complicated single-port access laparoscopic-assisted vaginal hysterectomy

“…Generally, a pelvic drain is placed to reduce postoperative morbidity by facilitating the removal of gas and pelvic fluid collection, to assess fluid characteristics, to check for any unsuspected hemorrhages in the surgical field, and to promote tissue apposition and wound healing without the need for further invasive procedures. A randomized study by Dua et al 12 suggested that the routine use of vault drainage during vaginal hysterectomy did not influence febrile morbidity, but there were no adverse outcomes noted with the use of the drain. The volume of fluid that may be drained even after extensive pelvic dissection using laparoscopy is unpredictable, and the decision to use postoperative drainage was based on the surgeon’s experience and the patient’s clinical condition.…”

“…Postoperative febrile morbidity was defined as a body temperature ≥ 37.5° C, a definition that has been used previously in a number of studies assessing postoperative infectious morbidity. 11 12 Temperature was measured every 4 hours in the postoperative ward, excluding the 1 st day after surgery. If a body temperature ≥ 37.5° C was noted on any postoperative day, we confirmed febrile status by checking the temperature hourly two times and appropriately controlling the fever.…”

Vaginal cuff closure technique and the risk for infected pelvic hematoma after vaginal hysterectomy

“…At present, there is paucity of data regarding the preferred cuff closure technique for vaginal hysterectomy. A trial assessing routine use of a vault drain during vaginal hysterectomy for benign disorders did not show any significant effect on postoperative morbidity [12]. Another study evaluated closure of the peritoneum and vaginal epithelium aiming to obliterate the space above the vaginal cuff and thereby reduce the incidence of vaginal vaults hematomas.…”