Efficacy and Complications of Absorbable and Non- Absorbable Sutures in Rectus Abdominis Plication: A Systematic Review.

Keywords: Rectus plication, diastasis recti, absorbable sutures, non-absorbable sutures, abdominoplasty. Background: Rectus abdominis plication is a key procedure in abdominoplasty to correct rectus diastasis. The choice between absorbable (e.g., polydioxanone) and nonabsorbable (e.g., nylon) sutures affects durability, complications, and cosmetic outcomes. This systematic review compares both types of sutures to guide surgical practice. Methods: A systematic review was conducted following PRISMA 2020, searching PubMed, Scopus, Web of Science, Scielo, Google Scholar, and LILACS through April 2025. Clinical studies comparing absorbable and nonabsorbable sutures in rectus plication were included, evaluating efficacy (correction, recurrence), complications (infection, dehiscence, seroma), and cosmetic outcomes. Quality was assessed using the Cochrane RoB 2 and Newcastle-Ottawa Scale. Data were synthesized narratively due to heterogeneity. Results: Of 460 records identified (400 after eliminating duplicates), 10 studies were included (5 RCTs, 5 observational, n=485 patients). Non-absorbable sutures (nylon, polypropylene) showed lower recurrence rates (0-5% vs. 15-40% at 12 months) but greater palpability in thin patients. Absorbable sutures (polydioxanone, Quill) had better cosmetic results in thin patients, although with more seromas (5-10%). Absorbable barbed sutures reduced operative time. The certainty of the evidence was moderate to low (GRADE). Conclusions: Non-absorbable sutures are preferable for durability, while absorbable sutures are ideal for cosmetic purposes in thin patients. The choice should be personalized according to the patient profile. More randomized controlled trials are needed to standardize practices.