Comparison of cosmesis score and patients perspective of total hysterectomy operation via laparoscopic and laparotomic technique

Purpose: The aim of our study is to evaluate the scar formation, wound healing results and patients perspective about cosmetic results of laparoscopic and laparotomic hysterectomy operation for benign gynecological indications. Material and method: Within the scope of the study, cases who underwent hysterectomy for benign gynecological reasons within 5 years from 2014 were evaluated. Cases who had surgery with conventional laparoscopic technique constituted the study group; cases who had laparotomy with transverse abdominal incision (Pfanenstiel incision) formed the control group. The information obtained from the cases and their files for the study was recorded in the patient questionnaire. Operation scars were measured with a digital caliper. Demographic and operative data of the cases, wound scar, scar length, thickness, color, and height from the ground and pain scores were compared. Patient scar satisfaction and general body perception evaluation questionnaires were evaluated among each other. Results: 50 patients who underwent laparoscopic total hysterectomy (TLH) operation constituted the study group, and 50 patients who underwent abdominal hysterectomy (AH) operation with Pfannenstiel incision constituted the control group. The average scar area was found to be significantly lower in the patients in the study group who had hysterectomy with laparoscopic technique (p=0.003). In the scar evaluations made by the physician, no significant difference was detected between the Manchester Score, POSAS-Doctor Scale Value, and Vancouver Scar Score scores. When patients' opinions about postoperative scars were evaluated, the average POSAS-patient scale value was significantly lower in the study group compared to the control group, while the body appearance survey score was, on the contrary, found to be high (p<0.01). There was no significant difference between the groups in the patients' mean Rosenberg scale score and body perception scale. Conclusion: Although laparoscopic hysterectomy is increasingly used by physicians due to better cosmetic results, body appearance survey scores of patients with laparoscopic hysterectomy may be lower. There is a need for studies that inform patients about scar locations before the operation, the selection of ports to be used in the operation, and the effect of the port site surgical repair technique on cosmetic results. Keywords: Patient satisfaction, Cosmetic results, Laparoscopic hysterectomy, Laparatomic hysterectomy, Scar