Abstract
Closed suction drains are placed 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. In this study we aimed to conduct the first robust systematic review comparing PTS and D outcomes in abdominoplasty. The study was registered on PROSPERO (CRD42022346106). We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Google Scholar, and Web of Science from September 19, 2022, to February 19, 2024. Data were pooled with a random effects Mantel-Haenszel model. Risk of bias was assessed with Cochrane's risk-of-bias tool and the ROBINS-I tool for randomized controlled trials and observational studies, respectively. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system evaluated methodological quality. PTS significantly reduced postoperative seroma rates (relative risk [RR] 0.34; 95% CI 0.15-0.76; P = .001) and reoperation rates (RR = 0.56; 95% CI 0.03-9.77; P = .05) compared to drains, with no significant differences in hematomas, infections, or dehiscence. The review included 24 studies with 750 patients, including 2 randomized controlled trials, and was found to be methodologically superior by AMSTAR 2 criteria. Subgroup analysis indicated that combining liposuction with PTS significantly reduced seromas (RR 0.18; 95%CI 0.00-7.39; P < .00001), infections (RR 0.16; 95% CI 0.03-0.86; P = .03), and dehiscence (RR 0.11; 95% CI 0.01-1.01; P = .05). This robust meta-analysis showed that PTS was more effective than drains in reducing seroma and reoperation rates, with no difference for hematomas or infections. Combining liposuction with PTS may be superior to placing drains. Larger, high-quality studies are needed to further assess the safety and efficacy of drainless abdominoplasty.