What is the treatment plan for seroma (fluid collection) in the abdomen following abdominoplasty (abdominal surgery)?

From the Guidelines

The treatment plan for fluid collection (seroma) after abdominoplasty should prioritize a conservative approach with compression garments and monitoring, reserving drainage procedures for larger or symptomatic collections, as routine use of drains has not been shown to confer significant benefits in preventing postoperative wound infection or fluid accumulation 1.

Key Considerations

• The use of intra-abdominal drains has been challenged, with evidence suggesting that they do not significantly reduce rates of mortality, morbidity, infections, or re-interventions in patients undergoing elective surgery 1.
• A recent prospective international matched cohort study found that drains were not associated with reduced rates or earlier detection of collections and were associated with delayed hospital discharge and an increased risk of surgical site infection 1.
• The World Society of Emergency Surgery guidelines recommend against the routine use of subcutaneous drains during the closure of abdominal wall incision, as high-quality evidence systematic reviews and meta-analyses demonstrate no advantage in preventing postoperative wound infection 1.

Management Approach

• For small seromas, a conservative approach with compression garments and monitoring may be sufficient.
• Larger or symptomatic collections may require drainage, which can be performed via needle aspiration in the surgeon's office, with possible repeated procedures until fluid production decreases.
• Patients should continue wearing compression garments as directed by their surgeon to help prevent fluid reaccumulation.
• Limiting physical activity and maintaining a slightly flexed position at the waist can reduce tension on the surgical site.
• Antibiotics are not routinely prescribed unless there are signs of infection.

Additional Interventions

• Persistent seromas may require additional interventions, such as sclerosing agents to seal the space or, rarely, surgical exploration to address the underlying cause.
• The use of triclosan-coated suture, wound protectors, and negative-pressure wound therapy may be considered to reduce surgical site infection, but their effectiveness in preventing fluid accumulation is not well established 1.

From the Research

Treatment Plan for Fluid Collection in Abdomen after Abdominoplasty

• The treatment plan for fluid collection in the abdomen after abdominoplasty involves early diagnosis and intervention to prevent complications such as wound-healing problems, infection, and patient discomfort 2.
• Ultrasound is a noninvasive, accurate, and low-cost method for diagnosing fluid collection in the abdominal wall, and can be used to guide the treatment plan 2.
• The use of imaging techniques such as CT scans and ultrasound can help to individualize the clinical and imaging approach to each patient suspected of an abnormal fluid collection or abscess 3.
• Fluid management in abdominal surgery requires a team approach, including anesthesiologists, surgeons, and intensive care physicians, to determine the optimal amount and type of fluid necessary in the perioperative period 4.
• In some cases, endoscopic ultrasound-guided drainage may be used to drain abdominal fluid collections that are not amenable to percutaneous drainage 5.
• It is important to note that small fluid collections can be a normal finding after abdominal surgery, and not all fluid collections require intervention 6.

Diagnostic Approaches

• Ultrasound is a useful diagnostic tool for detecting fluid collection in the abdominal wall after abdominoplasty 2.
• CT scans can provide accurate detection of intra-abdominal abscesses, but may not be necessary for all patients 3.
• Percutaneous aspiration and drainage of post-operative abdominal fluid collections is a well-established standard technique, but may not be suitable for all patients 5.

Treatment Options

• Early intervention, including drainage and antibiotic therapy, may be necessary to prevent complications such as wound-healing problems and infection 2.
• Fluid management strategies, including the use of crystalloids and colloids, can help to optimize fluid balance in the perioperative period 4.
• Endoscopic ultrasound-guided drainage may be considered for patients with abdominal fluid collections that are not amenable to percutaneous drainage 5.