Complication Prevention in Combined Abdominoplasty and Gynecologic Procedures: A Multidisciplinary Narrative Review

Abstract

Combined abdominoplasty (ABP) and open gynecologic surgery is an established approach that may reduce anaesthesia exposure, shorten convalescence, and lower costs relative to staged procedures, yet its safety profile and optimal perioperative management remain incompletely defined, with a heterogeneous evidence base and no updated synthesis since 2007. We conducted a narrative review, searching PubMed, MEDLINE, and Scopus from inception to March 2026 for studies of combined open ABP and gynecologic procedures in adults; fourteen studies published between 1983 and 2022 were included, comprising retrospective cohorts, case series, case-control and observational studies, one literature review, and two case reports (sample sizes 1 to 269). Reported outcomes were heterogeneous: some early series described longer operative times and greater morbidity, whereas recent comparative data found combined ABP-hysterectomy associated with a complication rate comparable to or lower than staged surgery (7.7% vs. 12.5%; p = 0.04) alongside reduced operative and anaesthesia times. Key modifiable risk factors include smoking, obesity, and ASA class. Formal venous thromboembolism risk stratification using the Caprini model with risk-adjusted prophylaxis, prophylactic antibiotics, maintenance of normothermia, separate instrument sets, and coordinated multidisciplinary planning are the principal evidence-based strategies for complication prevention. Rare delayed complications, notably abdominal-wall endometrioma, are consistently missed by short-term follow-up. Combined ABP and open gynecologic surgery can be performed safely in appropriately selected patients, although the evidence is limited by retrospective designs and outcome heterogeneity; prospective multicentre studies with standardised reporting and long-term follow-up are needed.