Volume : 7, Issue : 7, July - 2018

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

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

Abstract :

<p>&nbsp;Background : Skin incisions have been traditionally been used for making skin incisions. Recent studies have</p> <div>shown that cutting diathermy causes less post-operative pain without signi􀃶cant difference in cosmetic outcome</div> <div>or complication rate.</div> <div>Aim : The aim of this study was to compare the cosmetic outcome of the skin incisions created with cutting diathermy and scalpel by</div> <div>assessing Patient and Observer Scar Assessment scale (POSAS) and Vancouver Scar Scale (VSS) and also comparing post-operative</div> <div>complications between two treatment groups with respect to seroma formation, incisional pain and wound infection.</div> <div>Methods : This was a prospective hospital based single centre study which was conducted in Dr. Jeyasekharan Hospital and Nursing home</div> <div>from period July 2015 to January 2017.A total of 66 patients who were 18 years and above and diagnosed with inguinal hernia were</div> <div>enrolled in the study. Patients were then randomized for skin incision using either diathermy or scalpel using table of random numbers into</div> <div>two groups of 33 each: Group A ( Scalpel group) and Group B (Cautery Group).</div> <div>Results :</div> <div>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</div> <div>respectively (p-0.134 and 0.313).</div> <div>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).</div> <div>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).</div> <div>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).</div> <div>5. Out of the total 66 subjects, no subject has received pre-op chemotherapy.</div> <div>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).</div> <div>7. Mean VAS score was seen to be signi􀃶cantly less in cautery group as compared to scalpel group at each follow up (p&lt;0.01).</div> <div>8. Both the groups were comparable with respect to Vancouver scar scale (10.21 vs 10.76; p-0.051).</div> <div>9. Both the groups were comparable with respect to objective and subjective component of Patient and Observer Scar Assessment Scale</div> <div>(p-0.11 and p-0.07).</div> <div>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).</div> <div>Conclusion: The present study thus concluded that cautery causes signi􀃶cantly lesser pain without any signi􀃶cant difference in cosmetic</div> <div>outcome or patient‘s satisfaction. Complication rate was also comparable between the two methods. We, thus recommend universal use of</div> <div>cautery to make abdominal skin incisions for hernia repair.</div>