A randomised control trial of intraoperative and early outcome in scalpel versus monopolar diathermy for midline abdominal incisions

BACKGROUND: Cutting diathermy is an alternative to scalpel for all layers of abdominal entry despite the perception that it impairs healing, increases infection risk and has worse cosmesis. This prospective, randomised, controlled trial was carried out to compare the intraoperative and early outcome in diathermy to scalpel for midline abdominal incisions in general surgery METHODS: The study was conducted from 1 October 2014 to 31 May 2016. Ethical approval was obtained. The incision time, wound size or area, and volume of blood loss were determined for each group of diathermy and scalpel. Results were analysed with SPSS version 23.0 RESULTS: Two hundred and thirty-four patients (93.6%) met the inclusion criteria and were successfully randomised to mode of entry incision - group A monopolar diathermy (118 patients), and group B scalpel (116 patients). The mean incision time was 3.9 ± 1.6 minutes, wound size or area was 54.8 ± 24.4 cm2, volume of blood loss was 46.0 ± 25.5 ml and volume of blood loss per area was 0.99 ± 0.7 ml/cm2 for group A, while the mean incision time was 5.6 ± 2.5 minutes, wound size or area was 57.3 ± 27.3 cm2, volume of blood loss was 62.2 ± 30.6 ml and volume of blood loss per area was 1.3 ml/cm2 ± 0.8 for group B, respectively. The differences in these means were statistically significant CONCLUSION: Incisions made with diathermy resulted in shorter incision time and lesser blood loss when compared to that made with the scalpel. There was no difference in the rate of surgical site infection. These procedural results favour the use of diathermy for abdominal entry