title: Assessment of cosmetic outcome after laparoscopic cholecystectomy among women 4 years after laparoscopic cholecystectomy: is there a problem?
abstract: BACKGROUND
  Advocates of single-port laparoscopic cholecystectomy (SPLC) claim that improved cosmetic outcome is one of its main benefits over conventional laparoscopic cholecystectomy (CLC). However, the published data quantifying the cosmetic outcome after CLC is sparse. This study aimed to determine the cosmetic outcome after CLC using a validated scar assessment tool.
  
  
  METHODS
  The patient scar assessment questionnaire was sent to all women ages 20-50 years who had undergone CLC at the Norfolk and Norwich University Hospital (Norwich), the Homerton Hospital (London), and the Musgrove Park Hospital (Taunton) in 2005 (n = 380). In all cases, the operation had been performed using a four-port technique. The patients were asked to give scores related to the appearance and symptoms associated with the scars at the time the questionnaire was completed.
  
  
  RESULTS
  Of the 380 patients, 195 responded to the questionnaire, giving a response rate of 51%. The median age of the responders was 39 years, and 63 (32%) of them had undergone previous surgery. The mean score for each section was low, indicating a favorable cosmetic outcome. This correlated with the global question answered with "excellent" for 4 of 5 categories and "good" for the remaining category. Nine patients highlighted dissatisfaction with the umbilical incision.
  
  
  CONCLUSIONS
  Patients perceive the cosmetic results after CLC as excellent. Therefore, SPLC seems to have a limited role in terms of improving cosmesis for patients undergoing cholecystectomy. Anecdotal evidence from the questionnaire suggests that the umbilical port may be the site of problems for some patients. Further investigation is needed to determine whether this is significant, especially because it may be exaggerated after SPLC.
authors.affiliation: Department of Upper GI Surgery, Norfolk and Norwich University Hospital, Norwich, Norfolk, NR4 7UY, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Bignell
authors.forename: Andrew
authors.initials: A
authors.lastname: Hindmarsh
authors.forename: Haritharan
authors.initials: H
authors.lastname: Nageswaran
authors.forename: Bhavani
authors.initials: B
authors.lastname: Mothe
authors.forename: Andrew
authors.initials: A
authors.lastname: Jenkinson
authors.forename: David
authors.initials: D
authors.lastname: Mahon
authors.forename: Michael
authors.initials: M
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D001504:Beauty; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002921:Cicatrix / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult