Determination of patient concerns in choosing surgery and preference for laparoendoscopic single-site surgery and assessment of satisfaction with postoperative cosmesis

Abstract

background and purpose: Laparoendoscopic single-site (LESS) surgery offers potential improvements in cosmesis and recovery over standard laparoscopy (SL). We report the factors with which patients are most concerned in choosing surgery and how these affect preference for LESS. In addition, we rate the satisfaction of scars after laparoscopy.

Patients and methods: Patients followed after a laparoscopic procedure completed two surveys. First, patients rated, on a 5-point Likert scale, the importance of pain, recovery time, cost, treatment success, scars, and complications in choosing surgery. In addition, they were asked their preference for LESS. In the second survey, the impact of scars on body image and cosmesis was assessed.

Results: Seventy-nine patients (median age 54.8 years, 65% male and 35% female) were treated for malignancy (53), donation (15), and benign indications (9). Treatment success (4.71 ± 0.81) and complications (4.22 ± 1.16) were most important, followed by pain (3.43 ± 1.21) and convalescence (3.65 ± 1.11), P<0.05. Cost was rated 2.68 ± 1.38, and cosmesis was 2.22 ± 1.13 (P<0.005). Cosmesis score increased in females (2.59 ± 1.08 vs 2.02 ± 1.12), patients <50 years (2.59 ± 1.09 vs 2.02 ± 1.12), and benign surgical indication (3.33 ± 1.12 vs 2.07 ± 1.06), P<0.05. LESS was preferred in 30.4%, SL in 39.2%. Concern for cosmesis was associated with LESS preference (48.5% vs 17.8%, P=0.004). Sex, age, and surgical indication also influenced this. On the body image scale, patients scored a mean 18.8 ± 1.5 of 20. Patients rated scar appearance 8.31 ± 1.80 of 10.

Conclusion: Patients who were treated with laparoscopy were most concerned with success and complication. Preference for LESS was influenced by concerns for cosmesis, sex, age, and surgical indication.