Drainage following radical hysterectomy and pelvic lymphadenectomy: dogma or need?

To compare the incidence of lymphocyst formation and postoperative morbidity in patients drained or not drained following radical hysterectomy and pelvic lymph node dissection for cervical or endometrial malignancy.

A prospective study was undertaken of consecutive patients undergoing radical hysterectomy and pelvic lymphadenectomy at the Regional Department of Gynaecological Oncology, Gateshead, United Kingdom, between February 1992 and September 1994. A Piver type II procedure was performed with nonclosure of the vaginal cuff and pelvic peritoneum. Patients were randomized at the end of surgery to have either two suction drains inserted along the pelvic sidewalls or to have no drains inserted. The detection of lymphocysts was made by clinical examination and abdominal ultrasound scan performed 8 weeks postoperatively.

Eight patients were excluded from the study when drains were deemed necessary to assess postoperative blood loss. Fifty-one were randomized to drains, and 49 to no drains. The detection of lymphocysts by ultrasound and clinical examination in the drained group (15.6 and 5.9%, respectively) was not significantly different from the group not drained (17.4 and 6.1%, respectively). There was no difference in postoperative morbidity in the two groups.

There appears to be no advantage to the routine use of pelvic suction drainage following radical hysterectomy and pelvic lymphadenectomy.