A Systematic Review and Meta-Analysis Evaluating the Surgical Outcomes of Progressive Tension Suturing Compared to Drains in Abdominoplasty Surgery.

ABSTRACT

BACKGROUND: Closed suction drains are used to prevent seroma formation after abdominoplasty, but evidence of their effectiveness is limited, and they may increase infection risk and patient discomfort. Previous meta-analyses comparing progressive tension suturing (PTS) to drainage (D) in abdominoplasty have been methodologically weak and small in sample size. OBJECTIVES: This study aims to conduct the first robust systematic review comparing PTS and D outcomes in abdominoplasty. METHODS: Registered on PROSPERO (CRD42022346106), the study searched MEDLINE, EMBASE, CENTRAL, Google Scholar, and Web of Science from 19/09/2022 to 19/02/2024. Data were pooled using a random-effects Mantel-Haenszel model. Risk of bias was assessed with Cochrane's Risk-of-Bias Tool and ROBINS-I tool for randomized controlled trials and observational studies, respectively. The GRADE system evaluated methodological quality. RESULTS: PTS significantly reduced post-operative seroma rates (RR 0.34; 95% CI 0.15-0.76; P=0.001) and reoperation rates (RR=0.56; 95%CI 0.03-9.77; P=0.05) compared to drains, with no significant differences in hematomas, infections, or dehiscence. The review included 24 studies with 750 patients, including 2 RCTs, and was found to be methodologically superior by AMSTAR2 criteria. Subgroup analysis indicated that combining liposuction with PTS significantly reduced seromas (RR 0.18; 95%CI0.00-7.39; P<0.00001), infections (RR 0.16; 95%CI 0.03-0.86; P = 0.03), and dehiscence (RR0.11; 95%CI 0.01-1.01; P=0.05). CONCLUSIONS: This robust meta-analysis shows PTS is more effective than drains in reducing seroma and reoperation rates, with no difference in hematomas or infections. Combining liposuction with PTS may be superior to using drains. Larger, high-quality studies are needed to further assess the safety and efficacy of drainless abdominoplasty.