A prospective interventional study to compare the efficacy of syringe suction drainage system for prevention of subcutaneous seroma formation as compared to abdominal closure without a drain


  • Sharmeen Vazifdar Department of Obstetrics and Gynaecology, Dr. Vithalrao Vikhe Patil Foundation’s Medical College and Hospital, Ahmednagar, Maharashtra, India
  • Urmila G. Gavali Department of Obstetrics and Gynaecology, Dr. Vithalrao Vikhe Patil Foundation’s Medical College and Hospital, Ahmednagar, Maharashtra, India




Caesarean section, Seroma formation, Subcutaneous drain, Obese, Syringe suction drainage system


Background: Seroma is a sterile collection of serous fluid in the subcutaneous tissue. The incidence ranges from 15-81%.Prophylactic drainage of wounds is aimed to reduce the wound complications and thereby the associated morbidity. Obese patients are at higher risk.There is documented beneficial effect of subcutaneous drains in obese gravida patients undergoing caesarean delivery.The most common complications of cesarean section (CS) are superficial surgical site complications including sepsis, seroma formation and breakdown.The likelihood of seroma formation without drains is 7.5 times more.Hence this study was conducted to assess the efficacy of syringe suction drainage system in prevention of seroma formation in patients undergoing CS.

Methods: The study was conducted in the Department of Obstetrics and Gynaecology at the Dr. Vithalrao Vikhe Patil Foundation’s Medical College and Hospital over a period of twelve months from December 2019 to December 2020. A comparative study was conducted on 100 patients who had undergone lower segment caesarean section and had a subcutaneous layer of more than 1.5 cm. We used a drainage system made of a nasogastric tube no 10 attached to a 10 cc disposable syringe creating negative pressure for 50 of those patients.

Results: Out of 50 patients in whom the drain was not used 7 developed discharge from wound and 2 patients developed wound gape while only 2 patients developed discharge from wound among those who had the drain placed.

Conclusion: The syringe suction drain system is an efficient and cost effective method for prevention of subcutaneous seroma in patients undergoing CS.


Ferraro F, Piselli P, Pittalis S, Ruscitti LE, Cimaglia C, Ippolito G, Puro V. Surgical site infection after caesarean section: space for post-discharge surveillance improvements and reliable comparisons. New Microbiol. 2016;39(2):134-8.

Bindal J. A clinical study to compare drain versus no drain in post cesarean section. Int J Reprod Contracept Obstet Gynecol. 2017;6(9):3903-6.

Aksamija G, Mulabdic A, Rasic I, Aksamija L. Evaluation of risk factors of surgical wound dehiscence in adults after laparotomy. Med Arch. 2016;70(5):369.

Manzoor B, Heywood N, Sharma A. Review of subcutaneous wound drainage in reducing surgical site infections after laparotomy. Surg Res Pract. 2015.

Chowdri NA, Qadri SA, Parray FQ, Gagloo MA. Role of subcutaneous drains in obese patients undergoing elective cholecystectomy: a cohort study. Int J Surg. 2007;5(6):404-7.

Khalifa AA, Abdelrazak KM, Abdelazim IA. Routine subcutaneous drain versus no drain in cesarean section for diabetic obese women: a randomized controlled trial. Int J Curr Microbiol App Sci. 2015;4(8):479-85.

Khan AQ, Kodalkar M. Role of Negative Suction Drain in Subcutaneous Plane in Reducing Laprotomy Wound Infection. Int J Sci Re. 2016;5(1):692-4.

Kelsey JL, Whittemore AS, Evans AS, Thompson WD. Methods in Observational Epidemiology: 26 (Monographs in Epidemiology and Biostatistics. 2nd Edition. ‎ OUP USA. 1996.

Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. 3rd Edition. Wiley Series in Probability and Statistics. 2003.

Chen C, Xu X, Yan Y. Estimated global overweight and obesity burden in pregnant women based on panel data model. PloS one. 2018;13(8):e0202183.

Gates S, Anderson ER. Wound drainage for caesarean section. Cochrane Database of Systematic Reviews. 2013;12.

Maharaj D, Bagratee JS, Moodley J. Drainage at caesarean section--a randomised prospective study. South Afr J Surg. 2000;38(1):9-12.

Hyldig N, Vinter CA, Kruse M, Mogensen O, Bille C, Sorensen JA, et al. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial. Int J Obstet Gynaecol. 2019;126(5):628-35.

Ramsey PS, White AM, Guinn DA, Lu GC, Ramin SM, Davies JK, et al. Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women undergoing cesarean delivery. Obstet Gynecol. 2005;105(5):967-73.

Allaire AD, Fisch J, McMahon MJ. Subcutaneous drain vs. suture in obese women undergoing cesarean delivery. A prospective, randomized trial. J Reprod Med. 2000;45(4):327-31.

Gunatilake RP, Swamy GK, Brancazio LR, Smrtka MP, Thompson JL, Gilner JB, Gray BA, Heine RP. Closed-incision negative-pressure therapy in obese patients undergoing cesarean delivery: a randomized controlled trial. AJP Reports. 2017;7(3):151.

Makama J, Ameh A. Surgical Drains. What the Resident Needs To Know. Niger J Med. 2008.

Karthick R. A Comparative study of Subcutaneous Single Closed Suction Drain Versus Simple Closure in Emergency Midline Laparotomy Wounds (Doctoral dissertation, Government Vellore Medical College, Vellore).






Original Research Articles