Role of routine vault drainage at vaginal hysterectomy
Article first published online: 17 JUN 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 119, Issue 8, pages 1015–1016, July 2012
How to Cite
Spencer, C., Fiadjoe, P. and Abdel-Razek, A. (2012), Role of routine vault drainage at vaginal hysterectomy. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 1015–1016. doi: 10.1111/j.1471-0528.2012.03316.x
- Issue published online: 17 JUN 2012
- Article first published online: 17 JUN 2012
- Accepted 26 January 2012.
We read with interest the article published by Dua et al.1 assessing the place of a vaginal drain in women who have undergone vaginal hysterectomy procedures for benign reasons. There are a few important points to add to this work, which may limit the conclusions reached by the authors. First, we note (as the authors do) that the study population consisted primarily (>85%) of postmenopausal women who are likely to have had small, atrophic uteri; these women do not have the same risks of vault haematoma formation as premenopausal women, whose uteri are more vascular, larger and may have significant uterosacral ligament fibrosis—all of which increase the risks of vaginal vault bleeding during surgery and hence of vault haematoma formation. The lack of inclusion of an adequate number of premenopausal women therefore affects the strength of the authors’ conclusions regarding the efficacy of a vaginal drain in such women. Second, the determination of vault haematoma formation was based on postoperative pyrexia during the early postoperative period. We would like to point out that morbidity from vaginal vault haematoma is not usually evident until day 7–14 after surgery and unless women were re-admitted with complications following surgery at this time, there is no way of knowing if women did indeed suffer from this complication. As a consequence of the wide range of presentations of vaginal vault haematoma, it could also be that women were treated by their own general practitioner as an outpatient with a course of broad-spectrum antibiotics. Third, the authors state that in the women who were randomised to have a vaginal drain in place, the removal time was left up to the operating surgeon. We would argue that this introduces bias into the results and the study design would have been more robust if the time period had been pre-determined for all women to eliminate this variation.