title: Parental and Volunteer Perception of Pyloromyotomy Scars: Comparing Laparoscopic, Open, and Nonsurgical Volunteers.
abstract: BACKGROUND
  Despite evidence from prospective trials and meta-analyses supporting laparoscopic pyloromyotomy (LP) over open pyloromyotomy (OP), the open technique is still utilized by some surgeons on the premise that there is minimal clinical benefit to LP over OP. Although the potential cosmetic benefit of LP over OP is often cited in reports, it has never been objectively evaluated.
  
  
  METHODS
  After internal review board approval, the parents of patients from a previous prospective trial who had undergone LP (n = 9) and OP (n = 10) were contacted. After consent was obtained, the parents and patients were asked to complete a validated scar scoring questionnaire that was compared between groups. Standardized photos were taken of study subjects and controls with no abdominal procedures. Blinded volunteers were recruited to view the photos, identify if scars were present, and complete questions if a scar(s) was seen. Volunteers were also asked about the degree of satisfaction if their child had similar scars on a four-point scale from happy to unacceptable.
  
  
  RESULTS
  Mean age was 7 years in both groups. Parental scar assessment scores were superior in the LP group in every category. Blinded volunteers detected abdominal scars significantly more often in the OP group (98%) vs. the LP group (28%; P < .001). The volunteers detected a scar in 16% of the controls, comparable to the 28% detected in the LP group (P = .17). The degree of satisfaction estimate by volunteers was 1.78 for OP and 1.02 for LP and controls, generating a Cohen's d effect size of 5.1 standard deviation units comparing OP to either LP or controls (very large ≥1.3).
  
  
  CONCLUSIONS
  Parents of children scored LP scars superior to OP scars. Surgical scars are almost always identifiable with OP while the surgical scars associated with LP approach invisibility to the observer, appearing similar to patients with no prior abdominal operation.
authors.affiliation: 1 Center for Prospective Clinical Trials, Children's Mercy Hospital Kansas , Kansas City, Missouri.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: 2 Department of Surgery, University of Wisconsin American Family Children's Hospital , Madison, Wisconsin.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Acher
authors.affiliation: 1 Center for Prospective Clinical Trials, Children's Mercy Hospital Kansas , Kansas City, Missouri.
authors.forename: Sohail R
authors.initials: SR
authors.lastname: Shah
authors.affiliation: 1 Center for Prospective Clinical Trials, Children's Mercy Hospital Kansas , Kansas City, Missouri.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Sharp
authors.affiliation: 2 Department of Surgery, University of Wisconsin American Family Children's Hospital , Madison, Wisconsin.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
mesh_terms: D002648:Child; D002921:Cicatrix / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D010465:Perception; D011446:Prospective Studies; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D014838:Volunteers / Q000523:psychology