Fibrin sealant(Hemarus Therapeutics Ltd.)

Seroma is the most common complication after abdominoplasty, particularly when combined with liposuction. Multiple preventive strategies exist, but their relative effectiveness remains unclear.

Using network meta-analysis (NMA), this study seeks to assess the relative efficacy of different seroma-prevention strategies in abdominoplasty with or without liposuction.

In accordance with PRISMA-NMA guidelines, we included randomized controlled trials and cohort studies comparing seroma prevention strategies in adult patients and reported the incidence of seroma and secondary outcomes including operative time, drainage volume, and postoperative complications. Strategies were evaluated using risk ratios (RR) or mean differences (MD), each reported with 95% credible intervals (CrI) and surface under the cumulative ranking curve (SUCRA) values through a Bayesian random-effects model.

A total of 22 studies (n = 1313) involving ten interventions were included. In pairwise meta-analysis, preservation of Scarpa fascia (SFP) significantly reduced seroma risk compared to two drainages (RR =0.36, 95% CI:0.20 to 0.65). In subgroup analysis, SFP remained superior in both liposuction (RR =0.13, 95% CI:0.03 to 0.56) and non-liposuction groups (RR = 0.44, 95% CI:0.23 to 0.85). Network meta-analysis ranked SFP highest (SUCRA = 82.77%). Among liposuction patients, SFP (SUCRA = 76.41%) and progressive tension sutures (SUCRA= 71.45%) ranked highest, while electrocautery was least favorable (SUCRA= 18.48%) and less effective than fibrin sealant (RR = 134.3, 95% CrI: 2.5 to 29732.6). Progressive tension sutures were associated with longer operative times. Fibrin sealant and multi-drainage approaches were more effective in reducing infections compared to electrocautery.

SFP, fibrin sealants, and progressive tension sutures may represent potentially useful strategies for preventing seroma in abdominoplasty with liposuction. Further studies with larger sample sizes and standardized definitions are needed to confirm these findings.

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