Scalpel versus Electrocautery Skin Incision for Elective Inguinal Hernioplasty – A Randomised Control Trial

Abstract

Background: Electrocautery reduces incision time and provides a nearly bloodless surgical field, allowing for faster dissection and lowering the risk of infection through instrument handling. Despite its advantages, concerns about scarring and wound infection rates have limited its use in some surgeries.

Objective: To evaluate the safety and effectiveness of skin incisions made with a scalpel versus electrocautery in patients undergoing elective inguinal hernioplasty.

Methods: This prospective, randomized controlled study was conducted at Aarupadai Veedu Medical College and Hospital, Puducherry, involving 80 patients scheduled for elective inguinal hernioplasty. Participants were randomly divided into two groups: Group A (scalpel, n=40) and Group B (electrocautery, n=40). Primary outcomes measured included postoperative wound healing and complications, while secondary outcomes were incision time, intraoperative blood loss, postoperative pain, and duration of hospital stay.

Results: The average age of participants was 47.65 years, with no significant differences between groups in terms of age, gender, residence, or physical characteristics. The electrocautery group had significantly shorter incision times and less intraoperative bleeding compared to the scalpel group (p<0.05). Additionally, patients in the electrocautery group experienced significantly lower pain scores and required fewer doses of analgesics at various postoperative intervals (p<0.05). There were no significant differences between the groups in terms of postoperative wound complications or hospital stay duration. The electrocautery group also had significantly better cosmetic outcomes, indicated by lower Manchester scar scores at 2 weeks, 1 month, and 3 months follow-ups (p<0.05).

Conclusion: Electrocautery for skin incisions in elective inguinal hernioplasty is superior to the scalpel, offering advantages such as shorter incision times, less bleeding, reduced postoperative pain, fewer analgesic needs, and better cosmetic outcomes without increasing the risk of postoperative complications or lengthening hospital stays. These findings advocate for the broader use of electrocautery in similar surgical procedures.