BACKGROUND: This study is to determine the prevalence of pericardial effusion requiring surgical intervention and compare patients’ outcomes with operative subxiphoid tube drainage and percutaneous catheter drainage of the effusion in Lagos University Teaching Hospital (LUTH). PATIENTS AND METHODS: This is a prospective study of 40 patients who presented to LUTH with moderate to severe pericardial effusions requiring drainage between January and December 2017. They were randomized into 2 groups; 20 patients in Group A and 20 in Group B who had operative subxiphoid drainage and percutaneous catheter drainage of their pericardial effusions under ultrasound guidance respectively. Overall prevalence of patients with pericardial effusion requiring drainage was determined. Complications that are procedure related were compared between the two groups. Patients were followed up for 3 months and rates of recurrence requiring re-intervention in both groups were also compared. RESULTS: About a third of patients with pericardial effusion in LUTH require a form of drainage, and 62.5% of them presented with cardiac tamponade. Four patients in Group A had complications while complication occurred in 1 patient in Group B (p value= 0.342). No mortality related to the procedure in any of the groups. Patients were followed up for a period of 3 months. No patient in Group A had recurrence; however 3 patients in Group B had recurrences which required further surgical interventions. This represents a 15% recurrence rate, p value is 0.065. CONCLUSION: The prevalence of pericardial effusion requiring drainage in Lagos University teaching Hospital, Lagos is 33.7%. Both operative subxiphoid drainage and percutaneous catheter drainage of pericardial effusion are safe and effective treatment strategies. However, the percutaneous catheter drainage approach has lower complication rates (5% vs 20%) but has more recurrence rate requiring reintervention (15% vs 0%) when compared to the operative subxiphoid drainages in this institution.