title: Impact of body image on patients' attitude towards conventional, minimal invasive, and natural orifice surgery.
abstract: OBJECTIVE
  A series of investigations proposed that patients' preference on minimal invasive and scarless surgery may be influenced by age, sex, and surgical as well as endoscopic history of the individual patient. However, it is unknown which psychological criteria lead to the acceptance of increased personal surgical risk or increased personal expenses in patients demanding scarless operations. We investigated whether individual body image contributes to the patient's readiness to assume higher risk in favor of potentially increased cosmesis.
  
  
  METHODS
  We conducted a nonrandomized survey among 63 consecutive surgical patients after receiving surgery. Individual body image perception was assessed postoperatively applying the FKB-20 questionnaire extended by four additional items. The FKB-20 questionnaire is a validated tool for measuring body image disturbances resulting in a two-dimensional score with negative body image (NBI) and vital body dynamics (VBD) being the two resulting scores. A subgroup analysis was performed according to the conducted operations: conventional open surgery = group 1, traditional laparoscopic surgery = group 2, and no scar surgery = group 3.
  
  
  RESULTS
  There was a significant correlation between a negative body image and the preference for scar sparing and scarless surgery indicated by a significantly increased acceptance of surgical risks and the willingness to spend additional money for receiving scarless surgery (r = 0.333; p = 0.0227). Allocated to operation subgroups, 17 of 63 patients belonged to group 1 (OS), 29 to group 2 (minimally invasive surgery), and 17 patients to group 3 (no scar). Although age and sex were unequally distributed, the groups were homogenous regarding body mass index and body image (NBI). Subgroup analysis revealed that postoperative desire for scar sparing approaches was most frequently expressed by patients who received no scar operations.
  
  
  CONCLUSIONS
  Patients with an NBI tend towards scarless surgery and are willing to accept increased operative risk and to spend additional money for improved postoperative cosmesis.
authors.affiliation: Department of Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany. wolfram.lamade@rbk.de
authors.forename: Wolfram
authors.initials: W
authors.lastname: Lamadé
authors.forename: Colin
authors.initials: C
authors.lastname: Friedrich
authors.forename: Christoph
authors.initials: C
authors.lastname: Ulmer
authors.forename: Tarkan
authors.initials: T
authors.lastname: Basar
authors.forename: Heinz
authors.initials: H
authors.lastname: Weiss
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Thon
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001828:Body Image; D003430:Cross-Sectional Studies; D004954:Esthetics; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000523:psychology*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods / Q000523:psychology*; D011184:Postoperative Period; D012307:Risk Factors; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000379:methods / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome