Cosmetic Outcome After Single Incision Laparoscopic Cholecystectomy and Conventional Laparoscopic Cholecystectomy: An Objective Comparison

Pankaj Garg, MBBS MS, Vikas Gupta, MBBS MS MCH, Jai D Thakur, MBBS. 1.Fortis Super Speciality Hospital, Mohali, India, 1.MMIMS, Mullana, India 2.Post Graduate Institute of Medical Sciences & Research, Chandigarh, India, 3. 3. Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA

Background
Single incision laparoscopic cholecystectomy (SILC) has been projected to have better cosmetic outcome as compared to conventional laparoscopic cholecystectomy (CLC). However, there is scarce data that has objectively compared the patient’s perception of cosmetic outcome after SILC & CLC.
Methods
The SILC & CLC patients, who were operated in the last two years, were personally interviewed and assessed using the Patient Scar Assessment Questionnaire. The patient scar questionnaire was divided into the following ?ve categories (with possible scores in parentheses): appearance (1-5), symptoms (1-5), scar consciousness (1-4), satisfaction with appearance (1-4), and satisfaction with symptoms (1-4). Each category question could have five or four possible responses (First two questions had 5 and the next three questions could have four possible responses). A lower score indicates a favorable cosmetic outcome.
Results
52 patients were included in the study, (SILC=25, CLC=27). The age, sex distribution and BMI were similar in both the groups. The scores of different parameters assessed as per Patient Scar Assessment Questionnaire – appearance (SILC- 1.08 ± 0.4, CLC-1.14 ± 0.5, p=0.57, not significant, two-sided t-test), symptoms (SILC- 1.16 ± 0.5, CLC- 1.18 ± 0.4, p=0.83, not significant, two-sided t-test), scar consciousness (SILC- 1.04 ± 0.2, CLC- 1.07 ± 0.3 , P= 0.6, not significant, two-sided t-test), satisfaction with symptoms (SILC- 1.12 ± 0.3, CLC- 1.18 ± 0.4, P= 0.52, not significant, two-sided t-test) and satisfaction with appearance (SILC-1.04 ± 0.2, CLC- 1.11 ± 0.3, P=0.34, not significant, two-sided t-test) – were similar in both the groups. The overall satisfaction scores were also statistically similar in both the groups (SILC- 5.44 ± 1.4, CLC- 5.70 ± 1.7, P=0.54, not significant, two-sided t-test). Overall, a majority of patients (>80%) in both the groups gave least score (1), indicating maximum satisfaction, in all the categories.
Conclusions
The patient perception regarding cosmetic outcome after single incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy was similar in both the groups. Single incision laparoscopic cholecystectomy doesn’t seem to offer any significant cosmetic advantage over conventional laparoscopic cholecystectomy. This finding is significant because cosmetic benefits are one of the major projected advantages of SILS over CLC. In case this is not so, then the case in favor of SILS would not remain strong considering the complexity associated with SILS, namely technically difficulty, higher risk of complications especially in patients with BMI>33, increased operating time, need for sophisticated instruments, no improvement in postoperative pain scores as compared to CLC and lack of long term data. This point needs to be assessed in detail by larger studies, as cosmetic benefit is projected as one of the major advantages of single incision surgery.

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