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Cosmetic issues of abdominal surgery: results of an enquiry into possible grounds for a natural orifice transluminal endoscopic surgery (NOTES) approach.

BACKGROUND AND STUDY AIMS
Decreased scarring is an advantage of minimally invasive surgery. The new experimental technique of natural orifice transluminal surgery (NOTES) aims at totally scarless surgery. We examined the general attitudes of patients and unaffected persons towards scarless surgery.


METHODS AND PARTICIPANTS
We used a 7-item questionnaire in structured interviews with hospital visitors, following detailed standardized explanation of terms used and of possible complications, to groups of 10 participants, during an "open ward" day. A visual analog scale (VAS) from 1 (none) to 10 (very much) was used for all but one item. Questions concerned the importance of cosmetic results in abdominal surgery, satisfaction regarding existing scars, hypothetical acceptance of increased risk as a trade-off for the absence of scars, and other issues. Data were analyzed for participants overall, and for three age groups and both sexes.


RESULTS
292 participants (male : female 1 : 1; mean age 43 years) completed the questionnaire. Cosmetic issues were rated as important (median 8), but acceptance of existing scars was also high in those affected (median 8, n=68). Approval of scarless surgery decreased with a presumed risk increase (from score 9 down to score 5), and overall an increase in risk of 10 % was judged to be acceptable as a trade-off for total absence of scarring. Younger people tended to be less satisfied with scars, but were also less inclined than older people to accept higher surgical risk in this hypothetical context.


CONCLUSIONS
People generally seem to favor scarless abdominal surgery, even with some increase in risk.