Korean J Hepatobiliary Pancreat Surg.  2016 Aug;20(3):127-132. 10.14701/kjhbps.2016.20.3.127.

Cosmetic selection of skin incision for resection of choledochal cyst in young female patients

Affiliations
  • 1Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
  • 2Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUNDS/AIMS
Open surgery for choledochal cyst has a disadvantage of skin incision scar from operative wound, which can be a definite disadvantage especially in young female patients. This study focused on the cosmetic aspect of skin incision for resection of choledochal cyst in young female patients.
METHODS
During a 2-year study period, 11 adult female patients aged less than 40 years underwent primary resection of choledochal cyst by a single surgeon. The cosmetic effect of two types of skin incision was evaluated.
RESULTS
The patients underwent mini-laparotomy through either a right subcostal incision (n=8) or an upper midline incision (n=3). The mean length of skin incision was 10 cm for right subcostal incisions and 9 cm for upper midline incisions. It took approximately 1 hour to repair the operative wound meticulously in both groups. At the 6 month to 1 year follow-up, a slight bulge on the skin scar was observed in 3 (37.5%) patients of the right subcostal incision group and 1 (33.3%) patient of the upper midline incision group.
CONCLUSIONS
The results of this preliminary study support the claim that cosmetic effect of the upper midline incision for CCD surgery appears to be non-inferior to that of the right subcostal incision if the incision is placed accurately and repaired very meticulously.

Keyword

Choledochal cyst; Skin incision; Cosmetics; Young female; Upper midline incision

MeSH Terms

Adult
Choledochal Cyst*
Cicatrix
Female*
Follow-Up Studies
Humans
Skin*
Wounds and Injuries

Figure

  • Fig. 1 Selection of incision for mini-laparotomy in female young adult patients with choledochal cyst. In patients with a relatively wide epigastrium (A), a right subcostal incision is more appropriate. In contrast, an upper midline incision appears to be more suitable for patients with a relatively narrow epigastrium (B).

  • Fig. 2 Operative photographs of upper midline mini-laparotomy in a 32-year-old female patient. (A) After skin marking of the bilateral subcostal margins, a 9.5 cm-long upper midline incision is made. (B) Hepatic hilum is displaced toward the midline after gauze packing at the right lateral side. (C) The wound is repaired meticulously and then adhesive tapes are applied. (D) The small skin stitches and wound drain are removed at 5 days after surgery.

  • Fig. 3 Aesthetic subunits of the abdominal region and adjacent areas. The upper midline incision is located at the upper midline aesthetic subunit which overlies the midline of the abdomen.14


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