A Meta-Analysis of the Effects of Abdominoplasty Modifications on the Incidence of Postoperative Seroma

Background: Seroma is the most common complication of abdominoplasty. Certain modifications to abdominoplasty may reduce the risk of seroma. Objectives: The authors evaluated the incidence of seroma for 3 abdominoplasty techniques: preservation of Scarpa's fascia, placement of progressive tension (or quilting) sutures, and application of fibrin glue. Methods: In this systematic review and meta-analysis, the Cochrane Library, MEDLINE, Embase, and the International Clinical Trials Registry Platform (World Health Organization) were searched to identify studies of patients who underwent abdominoplasty with seroma as a potential "outcome." RevMan 5.3 was utilized for data management, statistical analyses, and graph preparation. Results: Fifteen studies (1824 total patients) met the criteria for inclusion in this review. The overall risk of bias was high, mainly owing to the nonrandomized nature of most studies. Abdominoplasty with preservation of Scarpa's fascia or placement of progressive tension sutures was associated with a significantly reduced incidence of seroma compared with that of standard abdominoplasty (P < 0.0001 and P < 0.0002, respectively). Abdominoplasty with application of fibrin glue was similar to standard abdominoplasty in terms of seroma development. Conclusions: Placement of progressive tension sutures or preservation of Scarpa's fascia during abdominoplasty may reduce the likelihood of postoperative seroma. Application of fibrin glue has no impact on seroma formation.