Obese Women’s Perception of Bariatric Trans-vaginal NOTES

Abstract

Much of the discussion pertaining to natural orifice transluminal endoscopic surgery (NOTES) focuses on technical issues, with little attention to women's perception and to their willingness to consent to this surgery, especially in the field of obesity. Aim of this study was to evaluate obese women's perception of NOTES and trans-vaginal access. Sixty two obese patients undergoing bariatric surgery were given a written description of NOTES with an anonymous questionnaire exploring their concerns and opinions regarding this technique. The risk of complications was the most important aspect with regard to surgical procedures for 87.1% of patients, while the aesthetic result counted only for 16.1%; none of the patients would accept an increased risk of surgical complications for a better aesthetic result, and 74.2% of them would prefer a standardized traditional surgical approach. Nulliparous women were more concerned about the potentially negative effects of NOTES on fertility than multiparous women and younger women were more worried about the effects on sexual function than older women. 83.9% of patients refusing NOTES stated that the main reason for their refusal was the lack of definitive data on the beneficial effects. Bariatric NOTES potentially offers obese women a scarless intervention, but only a few obese women expressed worries about the cosmetic/aesthetic effects of surgery, while most of them were worried about effects on future fertility and sexual life. Our study highlights a strong need for early reporting of outcome data to enlighten patients about this new approach to bariatric surgery.

Public Perception of “Scarless” Surgery: A Critical Analysis of the Literature

“…20 Overall, 62 patients (mean body mass index 45.3 kg/m 2 ) entered the study. The risk of complications was classified as the most important factor by 87.1% of patients.…”

“…16 In the study by Rocchietto et al, 83.9% of patients stated that they were concerned about the postoperative infection rate related to NOTES. 20 Among younger patients, all reported concerns about NOTES' effects on their sexual activity and the potential risk of dyspareunia. Moreover, the influence of NOTES on future fertility was considered very important for 85.7% of the nulliparous women who were surveyed.…”

Consumer demand for surgical innovation: a systematic review of public perception of NOTES

“…In the five studies which also asked about preference of NOTES access routes, four reported an overwhelming preference for transoral or transgastric access [18,22,23,26], whereas transrectal access was the preferred route in the study by Hucl et al [27]. All studies which included the option of transvaginal access reported this to be the least preferred option.…”

“…When asked to compare to laparoscopy, preference rates for NOTES ranged from 26 [22] to 78 % [23] in seven studies. Across all studies, 48 % (1,163/2,405) patients indicated a preference for NOTES.…”

“…Concerns regarding the access route were reported in only three studies. All patients less than 40 years of age reported concerns about their sexual function when considering transvaginal bariatric surgery in the study by Rocchietto et al [22]. In a single study, a minority of patients (14 %) were reported by Kim et al [26] to reject NOTES because of the route of access.…”