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Seroma Formation after Abdominal Lipectomy; a Systematic Review and Meta-analysis
Ali Izadpanah, MD,CM, MSc1, Jonathan Kanevsky, BSc2, Arash Izadpanah, MD, CM3, Liquin Xu2, Eric Belzile, BSc2, Lucie Lessard, MD, FRCSC, FACS2, Al Aly, MD, FACS4.
1McGill University, Westmount, QC, Canada, 2McGill University, Montreal, QC, Canada, 3University of Manitoba, Winnipeg, MB, Canada, 4University of California, Irvine, Orange, CA, USA.

Seroma Formation after Abdominal Lipectomy; a Systematic Review and Meta-analysis
Introduction
Abdominal lipectomy is a commonly performed procedure due to the increasing prevalence of obesity and bariatric surgery for aesthetic and functional purposes. However it is not short of complications. Seroma is a post-operative complication which can lead to associated morbidities. Thus, we sought to perform a systematic review and a meta-analysis to further identify the efficacy of potential proposed preventive measures for preventing post-operative seroma in abdominal lipectomy/abdominoplasty patients.
Method
A Medline search was performed for all relevant articles describing the incidence of seroma after abdominal lipectomy or abdominoplasty. The PubMed database of the National Center
for Biotechnology Information, National Library of Medicine (Bethesda, Md), Google Scholar, and Medline was used to collect reports using the key words “lipectomy”, “seroma”, “abdominal lipectomy”, and “body contouring”. All articles were reviewed for reports of clinical cases, complications, number of patients, seroma prevention method, seroma rate and study design. The difference of seroma rates between use of drains, progressive tension sutures, and minimal undermining was compared by meta-analysis. Comparing the use of electrocautery versus sharp dissection was not possible due to limited number of studies.
Results
24 studies including a total of 2,782 cases of abdominal lipectomies were identified, 19 retrospective, 3 prospective, 2 randomized controlled trials. The overall rate of seroma formation was 14%. Studies with no mention of any preventive methods had a higher rate of seroma formation at 16% (p>0.05). Placement of drains decreased the incidence of seroma to 14%. Placement of quilting stitches and minimal undermining decreased the incidence to 12% (p>0.05).
Conclusion
Our present systematic review and meta-analysis of 2,782 cases suggests that the use of drains, quilting stitches, and minimal undermining could reduce the rate of seroma formation in abdominal lipectomy procedures. Unfortunately due to limited number of studies and absence of adequate number of randomized control trials, results could not be demonstrated to be statistically significant. However, it still stays a complication occurring between 12-14 %. Further randomized control trials are necessary.
Table 1 : Seroma failure associated with abdominal lipectomy
No. of studiesFixed effects model (95% CI)I2Random effects model (95% CI)Test of heterogeneity (Q2) p-valueMETAREG p-value
Overall effect240.12 [0.11; 0.13]88%0.14 [0.10; 0.18]<0.0001
Type of prevention0.893
Only drain(3)140.11 [0.10;0.13]83%0.14 [0.09; 0.18]<0.0001
No method (4)60.12 [0.10; 0.14]94%0.16 [0.07; 0.27]<0.0001
Other (1,13,23,35)40.16 [0.10; 0.22]86%0.12 [0.01; 0.31]<0.0001
Study Design0.984
Retrospective190.12 [0.10; 0.13]90%0.14 [0.10; 0.19]<0.0001
Prospective30.11 [0.05; 0.18]78%0.13 [0.01; 0.34]0.015
RCT20.15 [0.06; 0.27]90%0.13 [0.01; 0.58]0.002


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