Comparison of the Results of Electrocautery and Scalpel Use in Abdominal Midline Incisions

Yıl 2024, Cilt: 10 Sayı: 1, 53 - 57, 01.01.2024

Gürcan Albeniz , Ozan Akıncı , Yasin Tosun

https://doi.org/10.53394/akd.1114464

Öz

Objective: Scalpel is the conventional instrument for laparotomy incisions. Electrocautery, on the other hand, can offer potential advantages such as blood loss, incision time, postoperative pain. In this study, we aimed to compare the clinical results of electrocautery and scalpel in abdominal midline surgical incisions.
Method: 146 cases who underwent elective abdominal midline incision between January 2020 – December 2021 were included in the study. The patients were divided into two randomized groups as electrocautery (n: 78) and scalpel (n: 68). The incision dimensions, incision time and blood loss during incision were noted intraoperatively. Postoperative pain and wound infection were recorded.
Results: The age and sex distribution was similar in the two groups. Incision time(seconds) in the electrocautery group (35.4±18.1) (57.6±25.3) was significantly shorter compared with the time in the scalpel group(p<0.001).The amount of bleeding was lower in the electrocautery group (p<0.001). Postoperative day 1 VAS score was significantly higher in the scalpel group however, the day 5 VAS score was higher in the electrocautery group (respectively; p<0.013 and p<0.001). There was no difference between the two groups in terms of postoperative wound complications (p>0.05).
Conclusion: Abdominal midline skin incisions performed by electrocautery are associated with faster and less blood loss compared with the incisions using scalpel. There was no difference between the two methods in terms of postoperative wound complications. The pain score of the scalpel on postoperative day 5 was lower than the pain score of the electrocautery.

Anahtar Kelimeler

: Electrocautery, scalpel, midline laparotomy, skin Incision, electrosurgery.

Abdominal Orta Hat İnsizyonlarda Elektrokoter ile Bistüri Kullanım Sonuçlarının Karşılaştırılması

Öz

Amaç: Laparotomi insizyonlarında geleneksel enstrüman bisturidir. Elektrokoter ise kan kaybı, insizyon süresi, postoperatif ağrı gibi potansiyel avantajlar sunabilmektedir. Bu çalışmada abdominal orta hat cerrahi insizyonlarda elektrokoter ile bisturinin klinik sonuçlarını karşılaştırmayı amaçladık.
Yöntem: Ocak 2020 – Aralık 2021 tarihleri ​​arasında elektif karın orta hat cilt insizyonu yapılan 146 olgu çalışmaya dahil edildi. Hastalar elektrokoter (n:78) ve bistüri (n:68) olmak üzere iki randomize gruba ayrıldı. İnsizyon boyutları, kesi süresi ve kesi sırasındaki kan kaybı intraoperatif olarak kaydedildi. Ameliyat sonrası ağrı ve yara enfeksiyonu kaydedildi.
Bulgular: Yaş ve cinsiyet dağılımı iki grupta benzerdi. İnsizyon süresi(sn) elektrokoter grubunda (35,4±18,1) bistüri grubuna (57,6±25,3) göre anlamlı ölçüde daha kısaydı (p<0,001). Kanama miktarı elektrokoter grubunda daha düşüktü (p<0,001). Postoperatif 1. gün VAS skoru, bistüri grubunda anlamlı ölçüde daha yüksek iken 5. gün VAS skoru elektrokoter grubunda daha yüksekti (sırasıyla; p<0,013 ve p<0,001). Postoperatif yara komplikasyonları açısından iki grup arasında fark yoktu (p>0.05).
Sonuç: Elektrokoter ile uygulanan abdominal orta cilt insizyonları bisturiye göre daha hızlı ve daha az kan kaybı ile ilişkilidir. Postoperatif yara komplikasyonları açısından iki metod arasında fark yoktur. Bistürinin postoperatif beşinci gün ağrı skoru elektrokotere göre daha düşüktür.

Anahtar Kelimeler

Elektrokoter, Bistüri, orta hat insizyon, cilt insizyonu

Kaynakça

• 1. Aird LN, Brown CJ. Systematic review and meta-analysis of electrocautery versus scalpel for surgical skin incisions. The American journal of surgery. 2012;204(2):216-21.
• 2. Rappaport WD, Hunter GC, Allen R, Lick S, Halldorsson A, Chvapil T, et al. Effect of electrocautery on wound healing in midline laparotomy incisions. American journal of surgery. 1990;160(6):618-20.
• 3. Soballe PW, Nimbkar NV, Hayward I, Drucker WR. Electric cautery lowers the contamination threshold for infection of laparotomies. The American journal of surgery. 1998;175(4):263-6.
• 4. Hajibandeh S, Hajibandeh S, Maw A. Diathermy versus scalpel for skin incision in patients undergoing open inguinal hernia repair: A systematic review and meta-analysis. International Journal of Surgery. 2020;75:35-43.
• 5. Groot G, Chappell EW. Electrocautery used to create incisions does not increase wound infection rates. The American journal of surgery. 1994;167(6):601-3.
• 6. Ly J, Mittal A, Windsor J. Systematic review and meta-analysis of cutting diathermy versus scalpel for skin incision. Journal of British Surgery. 2012;99(5):613-20.
• 7. Middeldorpf AT. Die Galvanocaustik: ein Beitrag zur operativen Medicin: Max; 1854.
• 8. Keenan KM, Rodeheaver GT, Kenney JG, Edlich RF. Surgical cautery revisited. Elsevier; 1984.
• 9. Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Alnawawi A, Maghrabi A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Canadian Journal of Surgery. 2019;62(2):111.
• 10. Johnson C, Serpell J. Wound infection after abdominal incision with scalpel or diathermy. Scalpel. 1990;130(68):18-95.
• 11. Ismail A, Abushouk AI, Elmaraezy A, Menshawy A, Menshawy E, Ismail M, et al. Cutting electrocautery versus scalpel for surgical incisions: a systematic review and meta-analysis. journal of surgical research. 2017;220:147-63.
• 12. Chrysos E, Athanasakis E, Antonakakis S, Xynos E, Zoras O. A prospective study comparing diathermy and scalpel incisions in tension-free inguinal hernioplasty. The American Surgeon. 2005;71(4):326-9.
• 13. Prakash LD, Balaji N, Kumar SS, Kate V. Comparison of electrocautery incision with scalpel incision in midline abdominal surgery–a double blind randomized controlled trial. International Journal of Surgery. 2015;19:78-82.
• 14. Charoenkwan K, Chotirosniramit N, Rerkasem K. Scalpel versus electrosurgery for abdominal incisions. Cochrane Database of Systematic Reviews. 2012(6).
• 15. Kearns S, Connolly E, McNally S, McNamara D, Deasy J. Randomized clinical trial of diathermy versus scalpel incision in elective midline laparotomy. Journal of British Surgery. 2001;88(1):41-4.
• 16. Kumar V, Tewari M, Shukla H. A comparative study of scalpel and surgical diathermy incision in elective operations of head and neck cancer. Indian journal of cancer. 2011;48(2):216.
• 17. Hussain S, Hussain S. Incisions with knife or diathermy and postoperative pain. Journal of British Surgery. 1988;75(12):1179-80.