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Cosmetic Outcome Following Laparoscopic Cholecystectomy - Is There a Problem?
Mark Bignell*1, Andrew Hindmarsh1, Bhavani S. Mothe2, David Mahon3, Andrew Jenkinson2, Michael Rhodes1
1Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom; 2Upper Gastrointestinal Surgery, Homerton University Hospital, London, United Kingdom; 3Upper Gastrointestinal Surgery, Musgrove Park Hospital, Taunton, United Kingdom
Introduction: Advocates of Single Incision Laparoscopic Surgery (SILS) claim that improved cosmesis is one of the main benefits over conventional laparoscopic cholecystectomy (LC). However, there is little published data quantifying the cosmetic outcome following LC. The aim of this study was to determine the cosmetic outcome after conventional LC using a validated scar assessment tool. MethodThe ‘Patient Scar Assessment Questionnaire’ (PSAQ) was sent to all female patients aged between 20 and 50 years who had undergone LC at two institutions in 2005 (n=279). In all cases the operation was performed using a 4 port technique. Patients were asked to give scores that related to the appearance and symptoms associated with the scars at the time of completing the questionnaire. Results 120 patients responded to the questionnaire with a response rate of 43%. The median age of responders was 39 years (range 20-50) and 42 (35%) had had previous surgery. Results are shown in the table below. The table shows that the mean score for each section was low indicating a favourable cosmetic outcome. This correlates with the global question for each category which is scored out of five where a score of one is ‘excellent’ and five is ‘very poor’. Four patients highlighted dissatisfaction with the umbilical incision.Conclusion Patients perceive the cosmetic results following LC as excellent. SILS would therefore seem to have a limited role in terms of improving cosmesis for patients undergoing cholecystectomy. Anecdotal evidence from the questionnaire suggests the umbilical port may result in a poorer cosmetic outcome. Further investigation is needed to determine if this is significant, especially as this may be exaggerated following SILS.
Legend - Patient scores for scars after LC in 119 women aged 20-50. Overall question score is 1 in all but one domain indicating excellent cosmetic results.
| Section (Score range) | Total Section Score | Overall Question Score | |
| Appearance (9 to 36) | Mean | 14.5 | 1.88 |
| Median (Range) | 14(9-27) | 2 | |
| Symptoms (6 to 24) | Mean | 6.4 | 1.05 |
| Median (Range) | 6(6-16) | 1 | |
| Scar Consciousness (6 to24) | Mean | 9.1 | 1.2 |
| Median (Range) | 8(6-16) | 1 | |
| Satisfaction with Appearance (6 - 24) | Mean | 12.5 | 1.43 |
| Median (Range) | 10(8-24) | 1 | |
| Satisfaction with Symptoms (5 - 20) | Mean | 6.7 | 1.21 |
| Median (Range) | 5(5-12) | 1 | |
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