title: Cosmetic outcomes following appendectomy in children: a comparison of surgical techniques.
abstract: BACKGROUND
  Although cosmetic superiority is widely stated as an advantage of single-incision laparoscopy, there are limited studies looking at cosmetic outcome. We sought to determine patients' cosmetic satisfaction after undergoing appendectomy by the single-incision laparoscopic appendectomy (SILA), multiport laparoscopic appendectomy (LA), or open appendectomy (OA) procedure.
  
  
  METHODS
  Five hundred eighty pediatric patients who underwent appendectomy at a single institution between February 2010 and July 2011 were identified and asked to complete the Patient Scar Assessment Scale (PSAS), a validated evaluation tool for linear scars. In addition, patients were asked the "Ultimate Question" (UQ), which correlates with a patient's overall satisfaction. Linear regression models were used to examine differences between surgical approaches with statistical significance set at P<.05. Covariates for all models included patient demographics, length of stay, and surgeon.
  
  
  RESULTS
  In total, 212 surveys were returned (SILA, 122; LA, 41; OA, 49) for a response rate of 37%. Regression models demonstrated significantly higher mean total PSAS scores for patients who underwent SILA and laparoscopic appendectomy (LA) appendectomy procedures compared with the open procedure (SILA, 8.70; LA, 8.86; OA, 8.01; β=-0.21, P<.05). Patients who experienced the SILA and LA procedures reported significantly higher mean UQ scores compared with OA (SILA, 9.79; LA, 9.75; OA, 9.39; β=-0.22, P<.05). SILA patients reported a 10 on the UQ significantly more often (91.1%) compared with either LA (81%) or OA (75.5%) (P<.05).
  
  
  CONCLUSIONS
  SILA or LA appendectomy was associated with significantly increased cosmetic satisfaction by patients and their families when compared with OA. This is the first study to show that pediatric patients value attempts to minimize scarring with laparoscopic surgery. Further studies are needed to determine if specific patient factors influence satisfaction with scars.
authors: 1 Division of Pediatric Surgery, All Children's Hospital/The Johns Hopkins School of Medicine , St. Petersburg, Florida.
authors: Nicole M
authors: NM
authors: Chandler
authors: Sharon R
authors: SR
authors: Ghazarian
authors: Tracy M
authors: TM
authors: King
authors: Paul D
authors: PD
authors: Danielson
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D004954:Esthetics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D017060:Patient Satisfaction; D011159:Population Surveillance; D012044:Regression Analysis; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome