Comparative study on safety and psychological adaptation between single-port transumbilical upper incision and transverse incision in bariatric surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Jie ¹ , WANG Senlin ² , XU Sunpeng ² , WANG Haibo ² , YANG Huawu ² , WANG Bing ² , YANG Jingge ³ , WU Li’na ³ , ZHU Hongmei ² ,  LIN Hongwei ⁴

1. Department of Medical Aesthetics, The Third People’s Hospital of Chengdu, Chengdu 610031, P. R. China;
2. Center for Minimally Invasive Gastrointestinal Surgery & Center for Obesity and Metabolic Diseases, Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu 610031, P. R. China;
3. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510632, P. R. China;
4. Department of Bariatric and Metabolic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing 100144, P. R. China;

Corresponding author：

LIN Hongwei, Email: linhw1973@126.com

Keywords：

single-port bariatric surgery; trocar placement; safety; scar appearance; psychological adaptation

DOI：

10.7507/1007-9424.202508040

Video：

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Objective To compare the safety of the incision along the upper umbilical margin (referred to as the “upper incision”) versus the transverse umbilical incision (referred to as the “transverse incision”) for single-port bariatric surgery, and to assess their effects on postoperative scar appearance and patient’s psychological adaptation. Methods This study was designed as a multi-center retrospective analysis. The patients who underwent bariatric surgery via the upper incision and transverse incision at the Third People’s Hospital of Chengdu, Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, and the First Affiliated Hospital of Jinan University from December 2024 to April 2025. The incidence of postoperative complications and the pionts of scar appearance (evaluated using the POSAS 3.0 scale) and psychological adaptation (measured with the BODY-Q scale) between the two incision methods were compared. Furthermore, multiple linear regression model was employed to evaluate the impact of different incision methods on points of scar appearance and psychological adaptation. Results A total of 194 patients who underwent single-port bariatric surgery were included, with 134 in the transverse incision group and 60 in the upper incision group. There was no statistically significant difference in the total incidence of incision complications between the transverse and upper incision groups [11.9% (16/134) vs. 18.3% (11/60), χ²=0.930, P=0.335]. The transverse incision group showed significantly better outcomes than the upper incision group in the overall points of BODY-Q scale [(39.86±1.02) points vs. (37.63±4.70) points, t=–6.090, P<0.001] and POSAS scale [(17.60±2.35) points vs. (21.25±6.00) points, t=5.239, P<0.001]. After adjusting for potential confounding factors such as history of diabetes mellitus, education level, smoking status, alcohol consumption status, keloid tendency, and use of scar improvement products in the multiple linear regression model, the advantage of the transverse incision remained significant [β(95%CI)=–1.81 (–2.84, –0.78), P<0.001]. Conclusions This study demonstrates that the transverse incision significantly improves the overall appearance of the postoperative scar and enhances patient’s psychological adaptation compared to the upper incision in single-port bariatric surgery. This advantage persists independently after adjusting for multiple confounding factors. Therefore, the transverse incision could be considered a more favorable approach in terms of cosmetic outcomes and patient’s psychological adaptation.

Citation： LIU Jie, WANG Senlin, XU Sunpeng, WANG Haibo, YANG Huawu, WANG Bing, YANG Jingge, WU Li’na, ZHU Hongmei, LIN Hongwei. Comparative study on safety and psychological adaptation between single-port transumbilical upper incision and transverse incision in bariatric surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1101-1106. doi: 10.7507/1007-9424.202508040 Copy

1.	Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg, 2008, 18(10): 1338-1342.
2.	Moreno-Sanz C, Morandeira-Rivas A, Sedano-Vizcaino C, et al. Single-incision laparoscopic bariatric surgery: a systematic review. Surg Obes Relat Dis, 2015, 11(1): 248-257.
3.	Haueter R, Schütz T, Raptis DA, et al. Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg, 2017, 104(9): 1141-1159.
4.	杨珵璨, 于洋, 王文越, 等. 单孔腹腔镜胃袖状切除术疗效的初步研究. 腹部外科, 2022, 35(5): 344-349.
5.	Lainas P, Derienne J, Dammaro C, et al. Single-port laparoscopic surgery for the treatment of severe obesity: review and perspectives. Obes Surg, 2020, 30(7): 2781-2790.
6.	Sun SD, Wu PP, Zhou JF, et al. Comparison of single-incision and conventional laparoscopic sleeve gastrectomy for morbid obesity: a meta-analysis. Obes Surg, 2020, 30(6): 2186-2198.
7.	Klassen AF, Cano SJ, Alderman A, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg Glob Open, 2016, 4(4): e679. doi: 10.1097/GOX.0000000000000665.
8.	Carrière ME, Mokkink LB, Tyack Z, et al. Development of the patient scale of the patient and observer scar assessment scale (POSAS) 3.0: a qualitative study. Qual Life Res, 2023, 32(2): 583-592.
9.	中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢外科综合管理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2023年度报告. 中华肥胖与代谢病电子杂志, 2024, 10(2): 73-83.
10.	Golkar FC, Ross SB, Sperry S, et al. Patients’ perceptions of laparoendoscopic single-site surgery: the cosmetic effect. Am J Surg, 2012, 204(5): 751-761.
11.	van der Laan L, Kuipers EAM, Timmerman JG, et al. Patient expectations of bariatric outcomes, baseline, and long-term evaluation. Obes Surg, 2025, 35(8): 3064-3074.
12.	Voth C, Kapani N, Silveira CBD, et al. The impact of comorbidities and surgical approach in incisional hernia development after minimally invasive cholecystectomy: a systematic review and meta-analysis of multivariate regression-adjusted studies. Hernia, 2025, 29(1): 148. doi: 10.1007/s10029-025-03340-9.
13.	Chen P, Jiao J, Xue H, et al. Exploration of umbilical hernia incidence and etiology in 753 cases of single-incision laparoscopic surgery: a retrospective analysis. BMC Surg, 2025, 25(1): 224. doi: 10.1186/s12893-025-02958-x.
14.	Deerenberg EB, Henriksen NA, Antoniou GA, et al. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg, 2022, 109(12): 1239-1250.
15.	Connell MB, Selvam R, Patel SV. Incidence of incisional hernias following single-incision versus traditional laparoscopic surgery: a meta-analysis. Hernia, 2019, 23(1): 91-100.
16.	Nguyen A, Huynh C, Goh A, et al. A systematic review of the management of postoperative scars with silicone gel-based products in randomized controlled trials. Dermatol Online J, 2023, 29(4). doi: 10.5070/D329461860.
17.	Stratis C, Haider SA, Oleru O, et al. Paper tape may improve scar aesthetics and prevent wound closure complications. Plast Aesthet Nurs (Phila), 2024, 44(1): 59-69.

1. Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg, 2008, 18(10): 1338-1342.
2. Moreno-Sanz C, Morandeira-Rivas A, Sedano-Vizcaino C, et al. Single-incision laparoscopic bariatric surgery: a systematic review. Surg Obes Relat Dis, 2015, 11(1): 248-257.
3. Haueter R, Schütz T, Raptis DA, et al. Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg, 2017, 104(9): 1141-1159.
4. 杨珵璨, 于洋, 王文越, 等. 单孔腹腔镜胃袖状切除术疗效的初步研究. 腹部外科, 2022, 35(5): 344-349.
5. Lainas P, Derienne J, Dammaro C, et al. Single-port laparoscopic surgery for the treatment of severe obesity: review and perspectives. Obes Surg, 2020, 30(7): 2781-2790.
6. Sun SD, Wu PP, Zhou JF, et al. Comparison of single-incision and conventional laparoscopic sleeve gastrectomy for morbid obesity: a meta-analysis. Obes Surg, 2020, 30(6): 2186-2198.
7. Klassen AF, Cano SJ, Alderman A, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg Glob Open, 2016, 4(4): e679. doi: 10.1097/GOX.0000000000000665.
8. Carrière ME, Mokkink LB, Tyack Z, et al. Development of the patient scale of the patient and observer scar assessment scale (POSAS) 3.0: a qualitative study. Qual Life Res, 2023, 32(2): 583-592.
9. 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢外科综合管理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2023年度报告. 中华肥胖与代谢病电子杂志, 2024, 10(2): 73-83.
10. Golkar FC, Ross SB, Sperry S, et al. Patients’ perceptions of laparoendoscopic single-site surgery: the cosmetic effect. Am J Surg, 2012, 204(5): 751-761.
11. van der Laan L, Kuipers EAM, Timmerman JG, et al. Patient expectations of bariatric outcomes, baseline, and long-term evaluation. Obes Surg, 2025, 35(8): 3064-3074.
12. Voth C, Kapani N, Silveira CBD, et al. The impact of comorbidities and surgical approach in incisional hernia development after minimally invasive cholecystectomy: a systematic review and meta-analysis of multivariate regression-adjusted studies. Hernia, 2025, 29(1): 148. doi: 10.1007/s10029-025-03340-9.
13. Chen P, Jiao J, Xue H, et al. Exploration of umbilical hernia incidence and etiology in 753 cases of single-incision laparoscopic surgery: a retrospective analysis. BMC Surg, 2025, 25(1): 224. doi: 10.1186/s12893-025-02958-x.
14. Deerenberg EB, Henriksen NA, Antoniou GA, et al. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg, 2022, 109(12): 1239-1250.
15. Connell MB, Selvam R, Patel SV. Incidence of incisional hernias following single-incision versus traditional laparoscopic surgery: a meta-analysis. Hernia, 2019, 23(1): 91-100.
16. Nguyen A, Huynh C, Goh A, et al. A systematic review of the management of postoperative scars with silicone gel-based products in randomized controlled trials. Dermatol Online J, 2023, 29(4). doi: 10.5070/D329461860.
17. Stratis C, Haider SA, Oleru O, et al. Paper tape may improve scar aesthetics and prevent wound closure complications. Plast Aesthet Nurs (Phila), 2024, 44(1): 59-69.

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Comparative study on safety and psychological adaptation between single-port transumbilical upper incision and transverse incision in bariatric surgery

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