St Peter Shawn D, Acher Charles W, Shah Sohail R, Sharp Susan W, Ostlie Daniel J
1 Center for Prospective Clinical Trials, Children's Mercy Hospital Kansas , Kansas City, Missouri.
2 Department of Surgery, University of Wisconsin American Family Children's Hospital , Madison, Wisconsin.
J Laparoendosc Adv Surg Tech A. 2016 Apr;26(4):305-8. doi: 10.1089/lap.2015.0566. Epub 2016 Mar 16.
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.
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.
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).
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.
尽管前瞻性试验和荟萃分析的证据支持腹腔镜幽门肌切开术（LP）优于开放幽门肌切开术（OP），但一些外科医生仍采用开放技术，理由是LP相对于OP的临床益处微乎其微。尽管报告中经常提到LP相对于OP潜在的美容益处，但从未进行过客观评估。
在获得内部审查委员会批准后，联系了先前一项前瞻性试验中接受LP（n = 9）和OP（n = 10）的患者的父母。获得同意后，要求父母和患者完成一份经过验证的瘢痕评分问卷，并在两组之间进行比较。对研究对象和未进行腹部手术的对照组拍摄标准化照片。招募不知情的志愿者查看照片，确定是否有瘢痕，并在看到瘢痕时完成相关问题。还询问志愿者，如果他们的孩子有类似瘢痕，他们的满意程度，满意度从“满意”到“不可接受”分为四个等级。
两组的平均年龄均为7岁。在每个类别中，LP组的父母瘢痕评估分数均高于OP组。不知情的志愿者在OP组（98%）中检测到腹部瘢痕的频率明显高于LP组（28%；P <.001）。志愿者在16%的对照组中检测到瘢痕，与LP组中检测到的28%相当（P =.17）。志愿者对OP组的满意度估计为1.78，对LP组和对照组的满意度估计为1.02，将OP组与LP组或对照组进行比较，Cohen's d效应量为5.1个标准差单位（非常大，≥1.3）。
儿童的父母对LP瘢痕的评分高于OP瘢痕。OP手术的瘢痕几乎总是可以识别的，而LP手术相关的瘢痕对观察者来说几乎不可见，看起来与未进行过腹部手术的患者相似。
