Patient satisfaction with long-term cosmetic outcomes of transumbilical vs. periumbilical incisions in laparoscopic cholecystectomy

Information from the abstract

Laparoscopic cholecystectomy has become the standard technique due to its advantages, such as smaller incisions, less pain, and faster recovery. The initial incision can be made using either a transumbilical (TUI) or periumbilical (PUI) approach, depending on the surgeon's preference. This study aims to compare the long-term cosmetic outcomes between TUI and PUI incisions in patients undergoing laparoscopic cholecystectomy. This retrospective cohort study with a cross-sectional assessment of long-term outcomes was conducted from April to December 2025. Patients aged 18 years or older who had undergone laparoscopic cholecystectomy more than one year previously were identified from hospital records. Patients with gallbladder cancer, delayed wound healing, or a history of previous umbilical surgery were excluded. The primary outcome was the overall patient satisfaction score regarding the long-term cosmetic appearance of the umbilical scar. Secondary outcomes included scar characteristics assessed using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS), as well as incisional umbilical hernia, wound numbness, wound hypersensitivity, and surgical site infection (SSI). The study included 80 patients, 40 in TUI group 40 in PUI group. The median follow-up duration was 38 months, with no significant differences in baseline characteristics between the groups. Overall patient satisfaction was high, with a median score of 9 (IQR, 9-10). The median satisfaction score did not differ significantly between the TUI and PUI groups (9 [IQR, 9-10] vs. 9 [IQR, 8-10], respectively; p = 0.50). No statistically significant differences were observed in the VSS total score, POSAS observer total score, POSAS patient total score, or POSAS patient overall score. However, the POSAS observer overall score was lower in the TUI group than in the PUI group (1 [1-2] vs. 2 [1-3.75], respectively; p = 0.03). SSI occurred in 11 patients (13.8%) all of which were superficial incisional infections. Incisional umbilical hernias developed in six patients (7.5%) and were detected between 24 and 123 months postoperatively. Patients who developed an incisional umbilical hernia reported significantly lower satisfaction scores than those who did not (median [IQR], 8 [4-8.5] vs. 10 [9-10], respectively; p = 0.04). Long-term patient satisfaction did not significantly differ between TUI and PUI approaches in laparoscopic cholecystectomy. Most secondary scar outcomes also did not differ significantly; however, the POSAS observer overall score was lower in the TUI group. This secondary finding should be interpreted cautiously because multiple outcomes were assessed without adjustment for multiple comparisons. The choice of incision should be individualized according to clinical and patient-specific considerations.

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