Randomized Controlled Study Comparing Diathermy and Scalpel Incisions for Elective Midline Abdominal Access in Jos University Teaching Hospital

Abstract

Introduction: Surgeons have traditionally made skin incisions with the scalpel. The introduction of diathermy for coagulation of bleeding vessels, cutting and fulguration of soft tissue has been used as an alternative to the scalpel for making skin incisions. Comparative studies have shown varying outcomes, and there are limited studies carried out in the Nigerian context. The objectives of this study were to compare wound outcomes and complication rates following the use of cutting mode diathermy and scalpel skin incisions for elective midline laparotomy.

Methods: In this prospective, hospital based, randomized controlled non-inferiority study, consenting patients undergoing elective open laparotomy were randomized into interventions of diathermy incision or scalpel incision using sealed envelopes with intraoperative allotment disclosure. Participants, care givers and outcome assessors were blinded to group allotment. Demographic characteristics and wound outcomes including incision time, incision blood loss, post-operative pain, and complications (infection, haematoma, and wound dehiscence) were observed and recorded. Primary end point was 30-day post-operative follow up. Data were analysed using the Fisher’s exact and independent sample t-test, with results represented in tables and figures.

Results: Forty-two of 50 enrolled patients (84%) attained the primary end point and were included in the final analysis with 21 patients analysed in the diathermy (Group A) and scalpel incisions (Group B). The two groups did not differ significantly with respect to age (p = 0.725), BMI (p = 0.904), wound length (cm) (p = 0.065), wound depth (cm) (p = 0.334), and wound area (cm²) (p = 0.985). The use of diathermy for skin incision for intraperitoneal access was significantly faster than the use of scalpel (p <0.001). The total skin incision wound blood loss was significantly less in the diathermy group compared to the scalpel group (p < 0.000) as well as the wound blood loos per unit wound area (p = 0.002). There was no significant difference in post-operative wound pain assessed using the Visual Analogue Scale on Day 1 (p = 0.270), Day 2 (p = 0.592), and Day 3 (p = 0.770). The post-operative wound complication rate did not differ significantly between the two groups (p = 1.000).

Conclusion: The use of diathermy incision for access in midline laparotomy significantly reduced wound incision time and incision blood loss compared to that of the scalpel incision. However, there was no significant difference in post-operative wound pain and complication rate between the two groups.

Key words: Diathermy, Scalpel, Laparotomy, Incision.