Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study


  • Amit Yadav Department of Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Lakshman Agarwal Department of Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Sumit A. Jain Department of Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Sanjay Kumawat Department of Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Sandeep Sharma Department of Surgery, SMS Medical College, Jaipur, Rajasthan, India



Electrocautery incision, Midline laparotomy, Scalpel incision


Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.

Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.

Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.

Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.


Centres for disease control and prevention, workbook for designing, implementing, and evaluating a sharps injury prevention program, 2010.

Perry J, Parker G, Jagger J. Percutaneous injury rates. Adv expos prevent. 2005;7:42-5.

Mumtaz S, Rehman M, Muzaffar M, Hassam M, Iqbal W. Frequency of seropositive blood donors for hepatitis B, C and HIV viruses in railway hospital, Rawalpindi. Pak J Med Res. 2001;41:51-3.

Ayandipo OO, Afuwape OO, Irabor D, Oluwatosin OM, Odigie V. Diathermy versus scalpel incision in a heterogenous cohort of general surgery patients in a Nigerian teaching hospital. Niger J Surg. 2015;21;43-7.

Siraj A, Farooqdar M, Gilani AAS, Raziq S. A study on comparison of diathermy and scalpel incisions in elective midline laparotomy. Prof Med J. 2011;18:106-11.

Allan SN, Spitz L, Noort R, Black MM. A comparative study of scalpel and electrosurgical incision on subsequent wound healing, J Pediatr Surg. 1982;17:52-4.

Aird LN, Brown CJ. Systematic review and meta analysis of electrocautery versus scalpel for surgical skin incisions. Am J Surg. 2012; 204:216-21.

Sowa DE, Masterson BJ, Nealon N, Fraunhofer JA. Effects of thermal knives on wound healing. Obstet Gynecol. 1985;66:436-9.

Johnson MA, Gadacz TR, Pfeifer ER. Comparison of CO2 laser, electrocautery and scalpel incisions on acute phase reactants in rat skin. Am Surg. 1997;63:13-6.

Sinha UK, Gallagher LA. Effects of steel scalpel, ultrasonic scalpel, CO2 laser, and monopolar and bipolar electrosurgery on wound healing in guinea pig oral mucosa. Laryngoscope. 2003;113:228-36.

Ozgiin H, Tuncyurek P, Boylu S. The right method for midline laparotomy: what is the best choice for wound healing? Acta Chir Belg. 2007;107:682-6.

Franchi M, Ghezzi F, Panici PL. Multicentre collaborative study on the use of cold scalpel and electrocautery for midline abdominal incisions. Am J Surg. 2001;181:128-32.

Papay FA, Stein J, Luciano M, Zins JE. The microdissection cautery needle versus the cold scalpel in bicoronal incisions. J Craniofac Surg. 1998;9:344-7.

Ozdogan M, Yilmaz KB, Ozaslan C. Scalpel versus electrocautery dissections: the effect on wound complications and pro-inflammatory cytokine levels in wound fluid. Turk J Med Sci. 2008;38:111-6.

Chrysos E, Athanasakis E, Antonakakis S. A prospective study comparing diathermy and scalpel incisions in tension-free inguinal hernioplasty. Am Surg. 2005;71:326-9.

Johnson CD, Serpell JW. Wound infection after abdominal incision with scalpel or diathermy. Br J Surg. 1990;77:626-7.

Kearns SR, Connolly EM, McNally S. Randomized clinical trial of diathermy versus scalpel incision in elective midline laparotomy. Br J Surg. 2001;88:41-4.

Rappaport WD, Hunter GC, Allen R. Effect of electrocautery on wound healing in midline laparotomy incisions. Am J Surg. 1990;160:618-20.

Kumagai SG, Rosales RF, Hunter GC. Effects of electrocautery on midline laparotomy wound infection. Am J Surg. 1991;162:620-3.

Shafighi M, Huemer GM, Meirer R, Katzer HP. Comparison of epigastric skin flap survival in sharp versus electrocautery dissection in a rat model. Plast Reconstr Surg. 2003;112:1503-4.

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






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