Diathermy versus Scalpel incision in elective midline laparotomy: A prospective randomized controlled clinical study

Background: Skin incisions have traditionally been made using a scalpel. Diathermy, a more recent alternative, is thought to increase the risk of infection, impair healing and decrease cosmesis. Recent studies suggest that diathermy may offer potential advantages with respect to blood loss, incision time and postoperative pain. The aim of this study was to compare the efficacy and safety of surgical diathermy incisions versus conventional scalpel incisions for midline laparotomy in our local setting with an aim to evaluate diathermy as an effective alternative to scalpel incision.
Methods: This was a prospective randomized clinical study which was conducted in the surgical wards of Bugando Medical Centre between January 2010 and December 2011. Patients were randomly assigned to two groups i.e. Group A (Scalpel group) and Group B (Diathermy group).
Results: A total of 214 patients were enrolled in the study. Of these, 108 patients were randomized to Group A (Scalpel group) and 106 patients to Group B (Diathermy group). The two groups did not differ significantly in relation to age and sex (p > 0.001). Laparotomy skin incisions using diathermy were significantly quicker than scalpel incisions (p = 0.001). There was significantly less blood loss in the diathermy group compared with the scalpel group (P = 0.012). The mean visual analogue scale was significantly reduced more in the diathermy group than in Group Scalpel group patients on postoperative day 1 (p =0.001), day 2 (p = 0.011) and 3 (p =0.021) respectively. The mean amount of intramuscular analgesic requirement was significantly less in the Diathermy group than in the Scalpel group (p= 0.021). Postoperative complication rates did not differ significantly between the Scalpel and Diathermy groups (p = 0.243). There was no significant difference between two groups with respect to the mean length of hospital stay (p = 0.834).
Conclusion: We conclude that diathermy incision in elective midline laparotomy has significant advantages compared with the scalpel because of reduced incision time, less blood loss, reduced early postoperative pain and analgesic requirements.