Randomized clinical trial of diathermy versus scalpel incision in electivemidline laparotomy

Background: Electrocautery is used increasingly for tissue dissection, alth ough fears of excessive scarring and poor wound healing have curtailed its widespread use for skin incision. This study compared electrosurgical incis ion with traditional scalpel incision. Methods: One hundred patients requiring elective midline laparotomy were ra ndomized prospectively to either scalpel or diathermy incision. Parameters measured included incision time, wound size, wound blood loss, total intrao perative blood loss and postoperative wound pain. All wound complications w ere recorded. Results: The two groups did not differ significantly in relation to patient or wound characteristics. Laparotomy incisions using diathermy were signif icantly quicker than scalpel incisions (mean(s.e.m.) 6.1(0.4) versus 7.5(0. 5) s/cm(2); P<0.04). There was significantly less blood loss in the diather my group compared with the scalpel group (0.8(0.1) versus 1.7(0.3) ml/cm(2) ; P = 0.002). Postoperative pain scores were significantly lower in the dia thermy group for the first 48 h after operation (P < 0.05). Morphine requir ements were also significantly lower over the first 5 postoperative days in the diathermy incision group (P < 0.04). There was no difference between g roups in wound complications before discharge and at the 1-month follow-up. Conclusion: Electrosurgical midline incision in elective surgery has signif icant advantages over scalpel use on the basis of incision time, blood loss , early postoperative pain and analgesia requirements.