A comparative study to evaluate the outcome between electrocautery versus scalpel skin incision in tension free inguinal hernioplasty: a tertiary care teaching centre experience

Abstract

Background: The use of cutting electrocautery instead of scalpel for skin incision is still suboptimal worldwide. There are many studies which include its use in general surgical operations but without use of prothetic material mostly, so our study aimed at its use in operations which include use of prosthetic material during abdominal wound closure means in tension free inguinal hernioplasty, exclusively. The objective of this study was to evaluate whether the application of extreme heat by cutting electrocautery may result in significant postoperative pain and poor wound healing with increased risk of wound infection in presence of underlying prosthetic material and poor cosmesis because of excessive tissue damage and scarring respectively as per previous hypothesis or it’s safe and effective instead. Methods: This is a retrospective clinical study conducted in the Department of Surgery, of a teaching tertiary care hospital in Sola, Ahmedabad between May 2013 to April 2014. Patients were allocated consecutively to have either scalpel or cutting electrocautery incisions. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection and cosmetic outcome were also noted. Results: A total of 196 consecutive patients included to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either electrocautery (n=98) or scalpel (n=98) groups. The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The incision time was shorter in the electrocautery group (P <0.001). The blood loss was less with the electrocautery compared to the scalpel (6.53±3.84 ml vs. 18.16±7.36 ml, P<0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation SD 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P<0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P=0.206). Conclusions: The use of cutting electrocautery in making skin incision during inguinal hernioplasty is as safe as scalpel in terms of wound healing and cosmesis and is also associated with reduced incision time, incisional blood loss, and postoperative pain.