Effectiveness of Hemovac drainage and Hemovac tip culture after Radical hysteretomy with Pelvic lymphadenectomy

Kwon, H K; Park, C K; Kim, J Y; Lee, J P; Jung, J E; Kang, S E; Kim, S N

Abstract

In preantibiotic era, pelvic drains had been utilized to decrease the postoperative complications such as febrile morbidity, fistula and lymphocyst formation, wound dehiscence due to pelvic infection. Nowadays, prophylactic antibiotics, transfusion, improved surgical technique and proper anesthesic management are being done for the prevention of postoperative complicatons. In Severance hospital hemovac drains was introduced in the early 1980`s and has been used since then. The purpose of this study was to evaluate the effectiveness of Hemovac tip culture study after radical hysterectomy with pelvic lymphadenectomy by reviewing 102 patients who took radical hysterectomy with pelvic and paraaortic lymphadenectomy at Severance hospital from March 1990 to December 1994. All of those patients had Hemovac drains inserted. Postoperative complications are compared according to the Hemovac tip culture results, and the significance of the tip culture will be studied. The postoperative complications were found as the following: Bladder atony that needed rehabilitation department consultation in 19 cases (17%), wound dehiscence in 12 cases (10.6%), urinary tract infection in 5 cases (4.5%), hemovac insertion site infection in 1 case (0.9%), lymphocyst formation in 3 cases (2.7%), cancer metastasis to hemovac insertion site in 1 case (0.9%). After the removal of hemovac drains, tip culture was routinely performed. In 76 cases (75.5%) no growth was noted, colonization of Staphylococcus coagulase negative growth in 17 cases (17.0%), Enterococcus faecalis growth in 4 cases (3.9%), Pseudomonas growth in 1 case (0.9%), Xanthomonas maltophilia growth in 1 case (0.9%), Candida albicans growth in 1 case (0.9%) and Klebsiella pneumonia growth in 1 case (0.9%). No statistical correlation could be found between the hemovac tip culture positive group and the incidence of ostoperative complication. Therefore as a conclusion, hemovac tip cultures are not mandatory for the purpose of postoperative complication surveillance if proper antibiotics coverage is done after surgery.