A comparison of two methods of pelvic drainage in laparoscopic hysterectomy: Foley catheter placement in the vaginal cuff versus abdominal drain placement

Objective: Infected pelvic hematoma is a serious complication of hysterectomies. Pelvic drainage can help reduce complications. This study was conducted to compare the placement of a Foley catheter through vaginal cuff as pelvic drain with the placement of an abdominal drain on laparoscopic hysterectomy and to evaluate the effects of these two different drainage methods on surgical and postoperative outcomes. Materials and Methods: A total of 77 patients who underwent laparoscopic hysterec-tomy between 2024 and 2025 at the Department of Obstetrics and Gynecology, Bezmialem Va-kıf University Hospital, were included in this prospective study. Based on the method of drain placement, the patients were divided into two groups: 41 patients with a vaginal Foley drain formed the case group (Group 1) and 36 patients with an abdominal drain formed the control group (Group 2). The patients' age, body mass index (BMI), chronic comorbidities, history of anticoagulant use, history of prior abdominal surgery, indication for hysterectomy, and whether oophorectomy or sentinel lymph node dissection was performed were recorded. The groups were compared in terms of operative time, preoperative and postoperative hemoglobin levels and their changes, postoperative C-reactive protein (CRP) levels, need for transfusion, febrile mor-bidity, pelvic hematoma, postoperative complications, postoperative pain score, pain score du-ring drain removal, limitation of mobilization, length of hospital stay and cosmetic evaluation of the surgical wound site. Results: Demographic characteristics were similar between the groups in terms of age, BMI, chronic diseases, prior abdominal surgery rates and anticoagulant use. Mean operative time was significantly shorter in the vaginal drain group (p=0.034). Postoperative hemoglobin levels were significantly higher in Group 1 (p=0.048). Although the hemoglobin change in ab-dominal drain group was higher, it was not statistically significant (p=0.070). Blood transfusi-ons were more frequently required in the abdominal drain group (Group 1: 2.4% vs. Group 2: 13.9%), but this was not statistically significant (p=0.092). Although CRP levels on postopera-tive day 1 were lower in the vaginal drain group, the difference was not statistically significant (p=0.821). Pain during drain removal was significantly lower in the vaginal drain group (p<0.001). Other pain-related outcomes and mobilization scores did not differ significantly (postoperative pain score: p=0.596; mobilization limitation: p=0.793). 87.8% of Group 1 pati-ents were discharged on the 1st or 2nd postoperative day, while 58.3% of Group 2 patients we-re discharged during this period. It was found that early discharge was significantly more com-mon in patients who received a vaginal drain compared to those who received an abdominal drain (p=0.017). The rates of postoperative complications were comparable (9.8% vs. 13.9%; p=0.726). Reoperation was required in one patient in each group (2.4% and 2.8%; p=1.000). Conclusion: This prospective study compared the surgical and postoperative outcomes of vaginal Foley drains and abdominal drains after laparoscopic hysterectomy. Vaginal drainage is a safe method that prioritizes patient comfort due to its ability to shorten the duration of sur-gery, maintain higher postoperative hemoglobin levels, cause less pain during drainage removal, shorten the length of hospital stay, not increase the risk of infection and have similar complica-tion rates. It should be noted that the findings may have been influenced by the presence of more complex cases in the abdominal drain group. Based on the data obtained, the vaginal drain met-hod offers a patient-centered approach in line with minimally invasive surgical principles and may be a strong alternative to abdominal drains in clinical practice. Larger, randomized studies are needed to confirm these results. Keywords: Laparoscopic hysterectomy, drain placement, vaginal drain, postoperative complications, pelvic hematoma, pain