S. R. Shah1, C. Archer2, D. J. Ostlie2, S. W. Sharp1, S. D. St. Peter1 1Children’s Mercy Hospital / University Of Missouri – Kansas City,Section Of Pediatric General And Thoracic Surgery,Kansas City, MO, USA 2American Family Children’s Hospital / University Of Wisconsin,Division Of Pediatric Surgery,Madison, WI, USA
Introduction:
Despite prospective trials and meta-analyses supporting laparoscopic pyloromyotomy (LP), the open technique (OP) is still utilized on the premise that there is minimal benefit to LP over OP. Despite the fact that the potential cosmetic benefit of LP over OP is often cited in reports, it has never been objectively evaluated.
Methods:
After IRB approval, the parents of patients from a previous prospective trial that had undergone LP (n=10) and OP (n=10) were contacted. After assent was obtained, the parents were asked to complete a validated scar scoring questionnaire which was compared between groups. Standardized photos were taken of study subjects and 5 controls with no abdominal procedures. Blinded volunteers were recruited to view the photos, identify if scars were present, and complete questions if scar(s) was seen. Volunteers were also asked about degree of satisfaction if their child had this result on a 4 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 (Table 1). Blinded volunteers detected abdominal scars significantly more often in the OP group (98%) vs. the LP group (28%) (P<0.001). The volunteers detected a scar in 16% of the controls, comparable to the 28% detected in the LP group (P=0.17). 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).
Conclusion:
Parents of children scored LP scars superior to OP scars. Scars are almost always identifiable with OP while the LP scars approach invisibility to the casual observer appearing similar to patients with no prior operation.
