Title: Role of Drainage and Peritoneal Closure after Radical Abdominal Hysterectomy and Bilateral Pelvic Lymph Node Dissection
Authors: Dr Achala Sahai Sharma M.S, Dr B.R Shrivastava Mch. Ph.D
DOI: http://dx.doi.org/10.18535/jmscr/v3i11.33
Whether to close or not to close visceral peritoneum and to drain or not to drain the peritoneal cavity after Radical Abdominal Hysterectomy with Bilateral Pelvic Lymph Node Dissection has been a controversial issue since long. Traditionally many advantages of peritonization and putting a pelvic drain have been emphasized. However studies have not proven these instead have indicated towards advantages of not putting drains and non closure of visceral peritoneum. The present study was undertaken to compare these two techniques. Aims and objective: To compare the post operative outcome in patients undergoing Radical Abdominal Hysterectomy with Bilateral Pelvic Lymph Node Dissection with drain and peritoneal closure or without drain and peritoneal non-closure. Patient and Methods: Ours was a prospective case control study over a period of 2 years 2 months. In this study 108 patients undergoing Radical Abdominal Hysterectomy with Bilateral Pelvic Lymph Node Dissection were enrolled. Group I (control group) consisted of 49 patients in whom visceral peritoneal closure was done and pelvic suction drains were cited. Group II (study group) consisted of 59 patients in whom peritoneal non closure was opted and suction drains were not placed. Patients were followed through the post operative period, observed for intra operative and post operative complications, need for blood transfusion, operative time, hospital stay, return of bowel activity and commencement of oral feeding. Occurrence of post operative complications that increase short term post operative morbidity like febrile illness, wound hematoma, infection, dehiscence, paralytic ileus were especially noted The detection of lymphocysts was made by clinical examination and abdominal ultrasound at two weeks, 12 weeks and one year postoperatively Result: Both groups were similar with respect to age and FIGO stage. The median follow up was 12 months (range 7 months to 24 months). There was no significant difference in the short term post operative complications including pain scores. Though not very significant but there is a shortening of operative time in group II with no significant differences in need of blood transfusion and other operative complications. Post operative ambulation and commencement of oral feeding was attained earlier in group II though again not significant. The diagnosis of lymphocysts by clinical examination in group I was made in three (6.1%) and six (12.2%) cases respectively and in group II three (5.08%) and five (8.4%) cases respectively. Out of these two (4.08%) cases in group I and none of the cases in group II required drainage. These differences were also not found to be significant. Conclusion: Present study indicates that leaving the peritoneum unsutured and not draining the peritoneal cavity by suction drains is not likely to be hazardous in the short term instead it may be of benefit especially in decreasing incidence of lymphocysts, though the long term effects with regard to future adhesion formation etc. need to be assessed after follow up. Thus both the procedures pelvic suction drainage and peritoneal closure can be safely omitted without any adverse effects. Keyword--- Abdominal drain, radical, hysterectomy, pelvic, lymph node, peritoneal closure.
Abstract
