Safety and Utility of the Drainless Abdominoplasty in the Post-Bariatric Surgery Patient

The Global Prevalence of Seroma After Abdominoplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Abdominoplasty is one of the most common cosmetic surgeries performed worldwide. Seroma is also the most common local complication associated with abdominoplasty, which increases care costs, reduces patient satisfaction, and has serious complications for patients. Results of previous studies report different levels of seroma prevalence after abdominoplasty. The aim of this study is to standardize the statistics of the prevalence of seroma after abdominoplasty using meta-analysis.

METHODS

In this systematic review and meta-analysis study, data from studies conducted on the global prevalence of seroma after abdominoplasty was extracted using the keywords "Prevalence, Epidemiology, Complications, Abdominoplasty, Seroma, and Lipo abdominoplasty" in the databases of Science, Scientific Information Database, MagIran, Embase, Scopus, PubMed, Web of Science, and Google Scholar search engine without time limit until October 2020. The random-effects model was used to analyze the eligible studies, and the heterogeneity of the studies was investigated with the I² index. Data analysis was performed using Comprehensive Meta-Analysis software (Version 2).

RESULTS

In reviewing 143 studies (five studies related to Asia, 55 studies related to Europe, three studies related to Africa, and 80 studies related to the Americas) with a total sample size of 27834 individuals, the global prevalence of seroma after abdominoplasty was obtained as 10.9% (95% CI: 9.3-3.6.6%) and the highest prevalence of seroma was related to the Europe continent with 12.8% (95% CI: 10.15-3.9%). The results from meta-regression showed a declining trend in the global prevalence of seroma after abdominoplasty with an increase in the sample size, age of study participants, and the year of study (p < 0.05).

CONCLUSIONS

This study shows that the prevalence of seroma after abdominoplasty is high globally. Therefore, physicians and specialists must consider its importance and take the controlling and treatment measures seriously.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Fibrin Sealant Artiss Compared to Progressive Tension Sutures With Stratafix in the Management of Wound Drainage Following Post-Bariatric Body-Contouring Surgery

Background

Post-bariatric body-contouring surgery is one of the most rapidly growing areas in plastic surgery. One of the most common complications following post-bariatric body-contouring surgery is seroma. There are a number of approaches to reducing wound drainage and seroma formation. A promising strategy to reduce these complications is to develop effective methods for reducing dead space between the tissue layers.

Methods

We conducted a retrospective trial assessing the use of human fibrin sealant Artiss in comparison to progressive tension sutures (PTS) with Stratafix, a bidirectional barbed suture device in patients undergoing post-bariatric body-contouring surgery. Thirty-six patients for abdominoplasty or lower-body-lift were evaluated. Treatment patients underwent procedure with fibrin sealant applied to adapt the tissue layers. Control patients underwent an identical procedure but with PTS. Primary outcome measures included total wound drainage and time to drain removal.

Results

The use of Artiss in abdominoplasty was associated with a mean drain volume that was significantly higher and more days that were needed to remove all drains compared to the PTS group. In body-lift, the mean drain volume and number of days needed to remove all drains tended to be higher when using Artiss compared to the PTS group.

Conclusion

The use of Artiss in post-bariatric body-contouring surgery did not decrease the rate of seromas and the length of time required for post-surgical drains when compared to PTS.

[Abdominoplasties: Do we still need to drain in 2021?]

OBJECTIVE

The purpose of this study was to consider the use of drainage when performing an abdominoplasty with regards to postoperative complications for two groups of patients.

PATIENTS AND METHOD

From January 1st 2017 to December 31th 2019, 215 patients underwent an abdominoplasty in our institution. In this retrospective, comparative, single institution study, patients were divided into two groups: "drainage" D (n=162) when suction completed abdominoplasty, "no drainage" ND (n=53) when suction didn't completed abdominoplasty. Early and distant complications were retrieved for each group and compared.

RESULTS

There was no significant difference between the two groups concerning the occurrence of seroma postoperatively (8% of patients in group D and 11.3% of patients in group AD). The drainage group D experienced more seroma's punctures (2,3± 1,0) and the mean of punctured fluid was higher (386,5ml±350,4ml) compared to the no drainage group ND (1,3+- 0,5 number of punctures with a mean punctured fluid of 165,8mL± 224,2mL). The mean hospital stay was shorter for group ND (2,9± 1,8 days) than for group D (4,4+- 1,7 days), P<0,0001.

CONCLUSION

Performing an abdominoplasty with quilting suture but drainless doesn't seem to increase postoperative complications statistically. The authors recommend, under the guise of a quilting suture, not to systematically drain the abdominoplasties and to reserve this technique for patients at risk of complications (high BMI, significant weight loss and co-morbidities).

Efficacy of Progressive Tension Sutures without Drains in Reducing Seroma Rates of Abdominoplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Abdominoplasty using progressive tension sutures (PTS) without drains has been reported to lower seroma risk. However, evidence regarding the reproducibility of PTS drainless abdominoplasty in lowering seroma risk is inconsistent and limited to a few studies.

OBJECTIVES

The purpose of this review and meta-analysis was to assess the efficacy of PTS without drains in reducing seroma rates associated with abdominoplasty.

METHODS

PubMed, EMBASE, and Cochrane databases were searched with no restrictions for randomized controlled trials (RCTs) and observational studies in which the number of patients who experienced postoperative seroma was indicated. The keywords included ''progressive tension sutures,'' ''quilting sutures,'' "drain," and "abdominoplasty.'' Review Manager software (RevMan, version 5.3) was utilized to compute the pooled effect estimate using a random-effects Mantel-Haenszel model. The outcomes were expressed as odds ratios (OR) and 95% confidence intervals (CI). Subgroup analysis was conducted based on whether abdominoplasty was combined with liposuction.

RESULTS

Five studies were included (one RCT and four retrospective studies) involving a total of 1255 adult patients. Patients who underwent abdominoplasty using PTS without drains experienced a significantly lower rate of postoperative seroma compared to those with drains (D) only (OR, 0.36; 95% CI, 0.19-0.70; P = 0.002; I² = 9%). There was no significant difference in postoperative seroma rates between the PTS and PTS + D groups (OR, 1.03; 95% CI, 0.30-3.54; P = 0.96; I² = 0%). The data analysis for the subgroup that included liposuction showed that compared with the use of drain only, PTS were associated with a significantly reduced number of seromas (OR, 0.24; 95% CI, 0.11-0.49; P = 0.0001; I² = 0%).

CONCLUSION

Abdominoplasty using PTS without drain and combined with liposuction was effective in reducing seroma rates. Additional RCTs with larger sample sizes and better comparability are needed to confirm the safety and effectiveness of the drainless abdominoplasty technique using progressive tension sutures.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Abdominoplasty without closed-suction drains: a randomised controlled trial]

INTRODUCTION

 There is insufficient scientific evidence from randomised controlled trials to support the routine use of closed-suction drains in body contouring procedures. The aim of this study was to evaluate cumulative seroma volume, length of hospital stay and complication rates in abdominoplasty patients without drains in direct comparison with a cohort receiving drains.

MATERIAL AND METHODS

 Abdominoplasty patients were prospectively randomised in two study groups with (MD) and without (OD) placement of closed-suction drains. Patients with a BMI ≤ 30 kg/m² undergoing horizontal or combined horizontal/vertical incision abdominoplasty were included. Scarpa's fascia was preserved during dissection. Exclusion criteria comprised simultaneous liposuction, coagulation disorders and ASA score ≥ 3. Cumulative seroma volume over a four-week follow-up period was assessed as the primary outcome measure. Secondary outcome measures were complications requiring surgical revision and length of hospital stay.

RESULTS

 This trial did not identify a statistically significant difference in cumulative seroma volume between the MD (30/53) and OD (23/53) cohorts in 53 patients (M_MD 493 ± SD 407 ml; M_OD 459 ± SD 624 ml; p = 0.812). However, a significantly shorter average length of hospital stay was observed in the OD population (M_MD 5.1 ± SD 1.4 d; M_OD 4.2 ± SD 1.5 d; p = 0.023). Complication rates were equal in both study groups (n_MD = 1; n_OD = 1).

CONCLUSION

 The results of this trial do not justify routine placement of closed-suction drains in abdominoplasty procedures (horizontal or combined horizontal/vertical incision) in the pre-obese patient cohort (BMI ≤ 30 kg/m²). Drain placement should be evaluated on an individual patient-specific basis.

Reduced Seroma Risk in Drainless Abdominoplasty Using Running Barbed Sutures: A 10-Year, Multicenter Retrospective Analysis

BACKGROUND

Drains are still commonly inserted during abdominoplasties despite extensive evidence documenting the benefits of drainless procedures. Continued improvements in progressive tension suturing (PTS) techniques and suture technologies have consistently shown a reduced seroma risk profile that outperforms procedures involving surgical drains.

OBJECTIVES

The aim of this report was to assess the authors' combined patient series, which represents the largest and longest-running, retrospective, multicenter set of abdominoplasty patients treated with a PTS technique involving running barbed sutures.

METHODS

Two surgical groups, each at different surgical centers, have for the past decade performed drainless abdominoplasties in which running barbed sutures were used. The results for all 445 patients in this series are reported by surgical center and pooled across centers.

RESULTS

The majority of the 445 patients underwent drainless abdominoplasty alone (n = 368; 82.7%); most of the remaining patients did so as part of a circumferential body lift (n = 55; 12.4%). Overall, 33 (7.4%) patients experienced a postoperative complication. The overall seroma rate was 4.7% (21 of 445 patients), but this dropped to 2.3% after surgical technique modifications were made to decrease upper abdominal dead space. The seroma incidence in this series is markedly lower than the 13% seroma rate with drains reported during the same time period and comparable to those seen in drainless abdominoplasties with interrupted suture techniques.

CONCLUSIONS

Drainless abdominoplasty involving PTS with running barbed sutures shows long-term reproducibility in lowering seroma risk compared to techniques in which drains are inserted, supporting results from published series of drainless abdominoplasty procedures that use interrupted suture techniques.

LEVEL OF EVIDENCE: 4

[Research progress of abdominoplasty]

Objective

To summarize the research progress of abdominoplasty.

Methods

The literature related to abdominoplasty in recent years was reviewed and the evolution of this surgical method and related surgical techniques were summarized.

Results

By removing excess skin adipose tissue from abdominal wall and strengthening loosening muscle fascia system, the abdominal wall contour can be improved by abdominoplasty. With the development of liposuction, selective flaps undermining, progressive tension sutures, and Scarpa fascia retention, the trauma and complications of abdominoplasty are significantly reduced, and better aesthetic result is achieved.

Conclusion

At present, the incidence of abdominoplasty complication is still the highest among cosmetic surgeries, and further exploration is needed to reduce complications and improve aesthetic effects.