Comparative randomized controlled clinical trial of diathermy versus scalpel incision in midline laparotomy

Bhavin P. Vadodariya, Nimish J. Shah, Mrudul Patel


Background: Laparotomy incisions have traditionally been made using a scalpel. Diathermy, a latest technique, is thought to increase the risk of infection, impair healing and decrease cosmesis. Recent studies suggest that diathermy may offer likely 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 hospital with an aim to evaluate diathermy as an operational alternative to scalpel incision.

Methods: This was a prospective randomized clinical study which was conducted in the surgical wards of Medical College & SSG hospital, Vadodara, between December 2013 and December 2014.  Patients were randomly assigned to two groups i.e. Group A (scalpel group) and Group B (diathermy group).

Results: A total of 148 patients were enrolled in the study. Of these, 74 patients were randomized to Group A (scalpel group) and 74 patients to Group B (diathermy group). The two groups did not vary significantly in relation to age and sex (p>0.001). Laparotomy skin incisions using diathermy were significantly quicker than scalpel incisions (p=0.624). There was significantly less blood loss in the diathermy group compared with the scalpel group (P=0.15). The mean visual analogue scale was significantly reduced more in the diathermy group than in scalpel group patients on postoperative day 1 (p=0.81), day 3 (p=0.71) and day 5 (p=0.79) respectively. Postoperative complication rates did not differ significantly between the scalpel and diathermy groups (p=0.624).

Conclusions: We concluded that diathermy incision in midline laparotomy has significant advantages compared with the scalpel because of reduced incision time, less blood loss, reduced early postoperative pain and postoperative wound infection.


Diathermy, Incision, Mid line laparotomy, Scalpel

Full Text:



Shivagouda P, Gogeri BV, Godhi AS, Metgud SC. Prospective randomized control trial comparing the efficacy of diathermy incision versus scalpel incision over skin in patients undergoing inguinal hernia repair. Recent Res Sci Tech. 2010;2(8):44-7.

Cushing H. Electrosurgery as an aid to the removal of intracranial tumors. Surg Gynecol Obstet. 1928;47:751-84.

Leaper DJ. Basic surgical skills and anastomosis. In: Russell RC, Williams NS, Bulstrode CJ, eds. Bailey and Love’s Short Practice of Surgery. 24th ed. London: Arnold; 2004:95-106.

Siraj A, Gilani AA, Dar MF, Raziq S. Elective midline laparotomy; comparison of diathermy and scalpel incisions. Professional Med J. 2011;18(1):106-11.

Duxbury MS, Blake SM, Dashfield A, Lambert AW. A randomised trial of knife versus diathermy in pilonidal disease. Ann Royal Coll Surg Eng. 2003;85(6):405-7.

Sheikh B. Safety and efficacy of electrocautery scalpel utilization for skin opening in neurosurgery. Brit J Neurosurg. 2004;18(3):268-72.

Laughlin SA, Dudley DK. Electrosurgery. Clin Dermatol. 1992;10(3):285-90.

Sigel B, Dunn MR. The mechanism of blood vessel closure by high frequency electrocoagulation. Surgery, Gynecol obstet. 1965;121(4):823-31.

Kumar V, Tewari M, Shukla HS. A comparative study of scalpel and surgical diathermy incision in elective operations of head and neck cancer. Ind J Cancer. 2011;48(2):216.

Cuschieri A, Steele RJ. Surgical craft and technology. In: Cuschieri A, Steele RJ, Moossa AR, eds.Essential Surgical Practice. 4th ed. Oxford: Butterworth- Heinemann; 2000:37-68.

Lodhi FB, Asrar R, Akram M, Hussain R. Incidence of abdominal wound dehiscence (midline vs paramedian incision closed with vicryl no. 1). King Edward Med Coll. 2001;7:38-40.

Dixon AR, Watkin DF. Electrosurgical skin incision versus conventional scalpel: a prospective trial. J Royal Coll Surg Edinburgh. 1990;35(5):299-301.

Kearns SR, Connolly EM, McNally S, McNamara DA, Deasy J. Randomized clinical trial of diathermy versus scalpel incision in elective midline laparotomy. Brit J Surg. 2001;88(1):41-4.

Drew PJ. Systematic review and meta‐analysis of cutting diathermy versus scalpel for skin incision. Brit J Surg. 2012;99(5):620.

Soballe PW, Nimbkar NV, Hayward I, Drucker WR. Electric cautery lowers the contamination threshold for infection of laparotomies 12. The Am J Surg. 1998;175(4):263-6.

Groot G, Chappell EW. Electrocautery used to create incisions does not increase wound infection rates. Am J Surg. 1994;167(6):601-3.

Chowdri NA, WaniNA GA. Naqash. SH, Peer. GQ, Wani. QA. Comparative study of electro surgical and scalpel incision in general surgery. IJS. 2002;63:308-10.

Emmanuel C, Elias A, Sokratis A, Evaghelos X, Odysseas Z. A prospective study comparing diathermy and scalpel incisions in tension-free inguinal hernioplasty. Am Surg. 2005;71(4):326-9.

Pollinger HS, Mostafa G, Harold KL, Austin CE. Comparison of wound-healing characteristics with feedback circuit electrosurgical generators in a porcine model. Am Surg. 2003;69(12):1054-60.

Peterson A. The use of electrosurgery in reconstructive and cosmetic maxillofacial surgery. Dental Clin North Am. 1982;26(4):799-823.

Mann W, Klippel CH. Electrosurgical skin incision. J Pedia Surg. 1977;12(5):725-6.

Kamer FM, Cohen A. High frequency needle dissection rhytidectomy. Laryngoscope. 1985;95(9):1118-20.

Tobin HA. Electrosurgical blepharoplasty: a technique that questions conventional concepts of fat compartmentalization. Ann Plastic Surg. 1985;14(1):59-63.

Telfer JR, Canning G, Galloway DJ. Comparative study of abdominal incision techniques. Brit J Sur. 1993 Feb;80(2):233-5.