Results of a systematic review and meta-analysis highlight the limitations of research investigating methods for preventing seroma after abdominoplasty/abdominal lipectomy and fail to demonstrate superiority of any one technique. However, the findings support use of some method to attempt to reduce the risk, said Ali Izadpanah, M.D., C.M., M.Sc., at the 91st annual meeting of the American Association of Plastic Surgeons.
For the entire population, the overall rate of seroma formation was 14 percent. The range across the various studies was wide, however, with a minimum of 6 percent and maximum of 50 percent. Seroma prevention methods identified as being used included drains, progressive tension sutures, quilting stitches, minimal undermining, or none. Due to the limited number of studies and their heterogeneity, all preventive methods other than drains and quilting sutures were pooled into a combination group.ANALYZING RESULTS In statistical analyses, there were no significant differences in seroma rates comparing any of the preventive measure groups; however, the rate of seroma with use of drains (14 percent) or quilting stitches (12 percent) was lower than when no preventive method was used (16 percent).
"Although seroma is well-known to be a common complication after abdominoplasty and abdominal lipectomy, there is a lack of evidence-based data on potentially effective seroma prevention methods," says Dr. Izadpanah, plastic surgery resident, McGill University, Montreal.
"The findings of this systematic review and meta-analysis reaffirm the limitations of existing research in this area and fail to show that any preventive method demonstrates superiority compared to other techniques. The messages for surgeons are that patients must be counseled preoperatively regarding the risk of seroma, and it appears that using either drains, quilting stitches, or a combination of methods is helpful to at least decrease the rate."
FOLLOWING INSPIRATION Dr. Izadpanah says he was motivated to undertake this research project after listening to a lecture by Al S. Aly, M.D., who commented on the lack of evidence-based data on seroma prevention methods for abdominoplasty or abdominal lipectomy. Dr. Aly is professor, director of aesthetics, Aesthetic and Plastic Surgery Institute, the University of California, Irvine, and was a visiting professor at McGill University.
"I was struck by that observation, considering how commonly these cosmetic surgery procedures are performed and the potential seriousness of seroma formation," Dr. Izadpanah says.
To identify studies for the systematic review and meta-analysis, Dr. Izadpanah undertook an online literature search using OVID MEDLINE, PubMed, Cochrane Database and Google Scholar with keywords "lipectomy," "seroma," "abdominal lipectomy," "abdominoplasty" and "body contouring." More than 600 studies were identified, but after careful review, only 28 met the meta-analysis inclusion criteria, indicating clearly the reported number of patients, the seroma and preventive method used. If no preventive method was mentioned, it was assumed none was used. The patient cohort was comprised of 3,138 abdominoplasty cases and 719 that underwent abdominal lipectomy.
REVIEWING SHORTCOMINGS "The major shortcoming of this project is that the studies eventually included in the analysis were so heterogeneous. Therefore, in order to try to maintain adequate power, it was not possible to look at only abdominoplasty or only abdominal lipectomy cases or to look individually at a wider range of preventive methods other than drains or quilting sutures. Even comparing the use of electrocautery versus sharp dissection was not possible because of limited numbers," Dr. Izadpanah says.
Dr. Izadpanah notes that ideally, methods for preventing seroma formation would be investigated in the context of a prospective, randomized controlled trial. He acknowledges that such a trial would have to be a multicenter collaboration in order to enroll the number of patients needed to achieve statistical power for differentiating between methods.
"Although some surgeons certainly have their own personal preferences for techniques they believe are beneficial for reducing the risk of seroma, there should be no ethical issues in conducting a randomized, controlled trial since there is no gold standard or evidence proving any method is better than another," Dr. Izadpanah says.