Abstract
Background: Scalpel incisions cause low injury to surrounding tissues. Electrosurgery has been used extensively
for hemostasis, but the risk of producing huge scars and
poor tissue recovery has kept it from being used in skin
incisions for the time being.
Aim: In patients with benign gynaecological disorders receiving abdominal incisions, to evaluate early postoperative and late term wound complications among scalpel and
electrosurgery.
Patient and method: Within a 20-month period, a randomised controlled trial (parallel group study with 1:1 randomization) was undertaken at the gynaecology department
of Alzhraa University Hospital in Cairo, Egypt.
We included 120 women in the trial after determining their
eligibility. 16 of them were disqualified for failing to satisfy
the inclusion criteria and refusing to participate. During follow-up, 14 patients were lost because they did not attend their
second appointment or did not provide their incision photo
to the first author (Shaimaa Ismail). Analysis was done on
90 participants, 45 in each group. Cases randomly assigned
at the operation day into two groups. Group A: scalpel used
for anterior abdominal wall incision and simple compression
or stitch for hemostasis , Group B: electrosurgery used for
same incision and hemostasis ( CUT and COAG ). Primary
outcomes: wound incision time/seconds and wound related
blood loss/grams). Secondary outcomes: postoperative pain
by VAS score, analgesia needed in first 12 hours postoperative in number of doses, wound infection and ugly scar formation at day 40.
Results: the electrosurgery group had a significantly low
wound related blood loss (7.39 g ± 5.5 g vs. 24.72 g ± 9.75
g; U = 137; P < 0.001) and lesser incision time (2.16±0.09 min vs. 3.9±1.58 min; U= 303; P < 0.001;
Mann-Whitney test) compared to scalpel
group. Electrosurgery significantly decrease
postoperative pain in both subjective and objective methods. There was no statistical difference found between the groups regard to
wound infection (P = 0.3; Fisher exact test ).
Conclusion: The proper use of electrosurgery
for abdominal wall incision could be a good
alternative for scalpel.
We registered our study protocol at www.clinicaltrials.gov . ClinicalTrials.gov Identifier:
NCT04236401