RANDOMIZED DOUBLE-BLIND TRIAL COMPARING THE COSMETIC OUTCOME OF CUTTING DIATHERMY VERSUS SCALPEL FOR INGUINAL HERNIOPLASTY SKIN INCISIONS.

Volume : VII, Issue : VII, July - 2018

Dr Anup Rajeev Mannali, Dr. Bala Vidyasagar, Dr. D. Devaprasath Jeyasekharan

Background : Skin incisions have been traditionally been used for making skin incisions. Recent studies have

shown that cutting diathermy causes less post-operative pain without signi􀃶cant difference in cosmetic outcome

or complication rate.

Aim : The aim of this study was to compare the cosmetic outcome of the skin incisions created with cutting diathermy and scalpel by

assessing Patient and Observer Scar Assessment scale (POSAS) and Vancouver Scar Scale (VSS) and also comp� post-operative

complications between two treatment groups with respect to seroma formation, incisional pain and wound infection.

Methods : This was a prospective hospital based single centre study which was conducted in Dr. Jeyasekharan Hospital and Nursing home

from period July 2015 to January 2017.A total of 66 patients who were 18 years and above and diagnosed with inguinal hernia were

enrolled in the study. Patients were then randomized for skin incision using either diathermy or scalpel using table of random numbers into

two groups of 33 each: Group A ( Scalpel group) and Group B (Cautery Group).

Results :

1. Mean age of the study subjects was 50.1 and 45.9 years while mean BMI was 25.8 and 25.3 Kg/m2 in scalpel and cautery group

respectively (p-0.134 and 0.313).

2. Out of the total 66 subjects, history of smoking was given by 30.3% subjects with no difference between the groups (p-0.789).

3. Out of the total 66 subjects, history of DM was found in 24.2% subjects with no difference between the groups (p-0.775).

4. Out of the total 66 subjects, history of Hypertension was given by 22.7% subjects with no difference between the groups (p- 1.0).

5. Out of the total 66 subjects, no subject has received pre-op chemotherapy.

6. Seroma formation was seen in 6 (18.2%) subjects of scalpel group as compared to 7 (21.2%) subjects in cautery group (p- 1.0).

7. Mean VAS score was seen to be signi􀃶cantly less in cautery group as compared to scalpel group at each follow up (p<0.01).

8. Both the groups were comparable with respect to Vancouver scar scale (10.21 vs 10.76; p-0.051).

9. Both the groups were comparable with respect to objective and subjective component of Patient and Observer Scar Assessment Scale

(p-0.11 and p-0.07).

10. Surgical site Infection was seen in 3 (9.1%) subjects of scalpel group as compared to 5 (15.2%) subjects in cautery group (p- 0.078).

Conclusion: The present study thus concluded that cautery causes signi􀃶cantly lesser pain without any signi􀃶cant difference in cosmetic

outcome or patient‘s satisfaction. Complication rate was also comparable between the two methods. We, thus recommend universal use of

cautery to make abdominal skin incisions for hernia repair.