Patient and parental scar assessment after single incision versus standard 3-port laparoscopic appendectomy: long-term follow-up from a prospective randomized trial.
BACKGROUND
Single site laparoscopy for appendectomy is a technique with several case series suggesting a cosmetic advantage, but without prospective comparative data. We conducted a prospective, randomized trial comparing single site laparoscopic appendectomy to the standard 3-port approach, including scar assessment at early and long-term follow-up.


METHODS
Enrolled patients over 12years old and parents of patients less than 12years old were asked to complete the validated Patient Scar Assessment Questionnaire (PSAQ) at early follow-up around 6weeks and by phone after 18months. The PSAQ consists of 4 scored subscales: Appearance, Consciousness, Appearance Satisfaction, and Symptom Satisfaction. Each subscale has a set of questions with a 4-point categorical response (1=most favorable, 4=least favorable). The sum of the scores quantifies each subscale.


RESULTS
Early questionnaires were obtained from 98 3-port and 100 single-site patients with the single-site approach producing superior overall scar assessment (P=0.003). By telephone follow-up, questionnaires were completed by 49 3-port and 56 single-site patients at a median of 25 (18-32) months. In this longer-term follow-up, overall scar assessment was not significantly different between groups (P=0.06).


CONCLUSIONS
Patients or parents express superior scar assessment with the single site approach at early follow-up, but this difference disappears in the long-term.
The Children's Mercy Hospital, Kansas City, MO.
Alessandra C
AC
Gasior
The Children's Mercy Hospital, Kansas City, MO.
E Marty
EM
Knott
The Children's Mercy Hospital, Kansas City, MO.
George W
GW
Holcomb
The Children's Mercy Hospital, Kansas City, MO.
Daniel J
DJ
Ostlie
The Children's Mercy Hospital, Kansas City, MO. Electronic address: sspeter@cmh.edu.
Shawn D
SD
St Peter
D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002921:Cicatrix / Q000209:etiology / Q000473:pathology* / Q000523:psychology; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
Appendectomy; Cosmetic; Laparoscopy; Pediatrics; Single-incision