The prospective study was conducted in the department of Surgery, Kalra Hospital from May 2011 to June 2012. All the patients undergoing elective abdominal surgery during the above period were included in the study. All patients of both sex above 16 years of age, requiring elective abdominal surgery, who agreed to regular follow-up visit and consented to be part of the study, were included. Patients with history of receiving antibiotics in preceding seven days, patient with previous surgical scar, those who receiving immuno-supportive therapy or undergone radiation therapy were excluded. Patient diagnosed with chronic pain syndrome or undergone treatment for pain management and pregnant women were also excluded. Institutional ethical clearance was obtained prior to conduction of study (NBE/Thesis/2048/2012/14169) and written informed consent was obtained. The candidates were divided into two groups- Group A, in which abdominal incision was made with a scalpel and Group B, in which abdominal incision was made with diathermy (setting of 70 watt with monopolar current was used). The incisions were of three types i.e., Kocher’s incision were 4, Midline were 22 and Pfannestiel were 44. A detailed history and clinical examination followed by investigations leading to confirmation of diagnosis and routine pre-anaesthetic investigations for fitness of the patient was undertaken. All patients received one dose of Inj. Ceftriaxone 1 gm I/V and Inj. Amikacin 500 mg I/V, as pre-operative and three doses as post-operative prophylaxis. The abdominal skin was prepared with povidone iodine. Incision time was calculated from the time of making incision to the time of opening peritoneum with complete homeostasis, with a stop watch and blood loss during incision was calculated using dry surgical mops which were weighed pre-operatively as well as post-operatively in a sterile manner, using weighing scale with 2 gram resolution. Pain assessment was done with Visual Analogue Score (VAS). Pain was represented on a 10 cm straight line, extremes of which corresponded to no pain at one end and the worst pain imaginable on the other end. All patients received eight hourly intramuscular diclofenac sodium injections for pain relief. VAS score was measured at 8, 14 and 24 hours respectively. All the patients were followed up in 2^nd and 4^th week after discharge to record any wound infections.

Data was entered into Microsoft excel data sheet and analysed using SPSS 22 version software. Categorical data was represented in the form of frequencies and proportions. Unpaired t-test was used as test of significance for qualitative data.

Patient included in the study were in second to seventh decade of life, youngest being 19 years and the oldest 73 years of age. Male to female ratio was 1:6. There was predominance of females as pfannestial incision is mainly used for hysterectomy and lower abdomen and pelvis approaches. Outcome parameters with respect to different types of incisions are shown in [Table/Fig-1,2 and 3]. There was statistically significant increase in the mean time taken for incision in Group A when compared with Group B in case of pfannestiel incision (310.18±72.63 and 231.5±112.45 respectively; p=0.009 [Table/Fig-3].

Similarly, mean blood loss was statistically higher in Group A when compared with Group B (31.91±9.06 and 14.91±12.28 gm respectively; p<0.001) [Table/Fig-3]. Only one patient each, developed wound infection in the scalpel and the electrocautery groups. Change in VAS score with respect to different type of incision at different interval of time is shown in [Table/Fig-4].

[Table/Fig-4]:

Change in VAS w.r.t time in different incisions and techniques

Initial studies with diathermy suggested that, electrosurgical incisions showed excessive scarring and poor wound healing. With the use of sinusoidal current, better control of energy dispensed was developed. In the present study, mean incision time and amount of blood loss was significantly reduced in electrocautery group in comparison to the scalpel group. These findings are in concordance with the study conducted by Nandurkar VS et al., in which statistically significant increase was noted in the mean time taken for incision in scalpel group when compared with electrocautery group (36.8±8.8 and 27.0±10.1 respectively; p<0.001) [1]. Our findings also corroborated with Chau JK et al., (210.33±68.82 in electrocautery group and 239±82.99 in scalpel group) and by Dixon AR and Watkin DF, (90±22 in electrocautery group and 126±25 in scalpel group) [6,7]. Similarly mean blood loss was statistically higher in Group A when compared with Group B (3.4±1.5 mL and 2.6±1.5 mL respectively; p=0.021) [1]. These findings are also similar to Talpur AA and Khaskheli AB, who in their study reported statistically significant reduction in mean incision time and mean blood loss with electrocautery when compared with scalpel [8].

Similarly, Ly J et al., in their systemic review and meta-analysis of fourteen randomised trials comprising of 2541 patients (1267 undergoing abdominal wall incision by cutting diathermy and 1274 by scalpel), noticed significantly reduced amounts of blood loss (mean difference of 0.72 mL/cm² (p<0.001) and shorter incision time (mean difference of 36 seconds; p<0.001) with diathermy incisions as compared to scalpel incisions [9]. The average pain score in present study was found to be lower in electrocautery group in all the incisions; however it was statistically significant in pfannestiel incision. These findings are similar to the findings by Nandurkar VS et al., which concluded that post-operative pain is significantly less (p-value 0.021) in the electrocautery group on day 1 [1]. Our findings are also similar to other published studies by Ayandipo OO and Afuwape OO, and Kearns SR et al., Aird LN and Brown CJ, also noted that electrocautery significantly reduced post-operative wound pain [2,10,11]. Other studies whose results are in agreement with the present study were by Siraj A et al., Gilmore M et al., and Shivagouda P et al., which showed that elective laparotomy incisions made with electrocautery had major benefits in terms of reduced early post-operative pain [12-14]. Only one patient in each group, developed wound infection in the scalpel and the electrocautery groups which was not statistically significant. These findings are similar to studies conducted by Nandurkar VS et al., and Talpur AA et al., [1,8].

Small sample size is major limitation of the study.

Electrosection proves to be safe and efficient than conventional scalpel method in terms of patient comfort, by causing less post-operative pain. Electrosection is the ideal method of incision in high risk patients, where both the blood loss and operating time are at premium.