Inguinal hernia repair is among the most common surgical procedures globally, with over 20 million surgeries performed annually. Lifetime incidence is 27–43% in men and 3–6% in women [1].

Surgical skin incisions may be made using either a scalpel or diathermy. Scalpel incisions are precise but may increase bleeding and pose injury risks to staff [2]. Diathermy, introduced in the early 1900s, uses alternating electric current for cutting and coagulation, minimizing bleeding and facilitating rapid tissue dissection [3,4].

Several studies suggest that diathermy reduces operative time, blood loss, postoperative pain, and analgesic requirements [6,2,7], although concerns remain regarding wound infection [8,9]. Due to these mixed findings, this study compared outcomes of diathermy versus scalpel incisions in elective open inguinal hernia repair.

MATERIALS AND METHODS

This prospective, randomized comparative study included 150 patients at Karnataka Medical College and Research Institute (June 2023–June 2025).

Inclusion Criteria:

1. Clinically diagnosed unilateral inguinal hernia scheduled for elective Lichtenstein repair.
2. Age 18–60 years, providing written informed consent.

Exclusion Criteria:

1. Complicated hernias (irreducible, obstructed, strangulated, bilateral, or recurrent).
2. Comorbidities affecting healing (immunosuppression, diabetes, steroid therapy, or chemotherapy).

Randomization and Intervention: Randomization was done through envelopes which were randomly distributed to the 2 groups

• Diathermy group (n = 75): Incisions with electrocautery needle in cut mode at 40 W.
• Scalpel group (n = 75): Incisions with surgical blade, hemostasis using forceps coagulation at 30 W.

Anesthesia: Spinal (3–3.5 ml of 0.5% heavy bupivacaine + 60 µg buprenorphine at L3–L4/L2–L3).

Postoperative Analgesia: IV paracetamol 1 g TID; tramadol 100 mg in 100 ml normal saline as rescue.

Outcomes:

1. Incision time (seconds)
2. Early postoperative pain (VAS at 6, 12, 24 h)
3. Wound complications (infection, hematoma, seroma)
4. Wound healing (assessed at first-week follow-up)

RESULTS

Age distribution

Incisional time

Gender distribution

VAS score of the patient on 6,12,24^th hour

Wound Complications:

DISCUSSION

The use of electrocautery for initial skin incisions remains debated, despite its well-established safety and effectiveness for subcutaneous and muscle layer dissection. Recent studies on diathermy have demonstrated promising outcomes, including shorter operating times, reduced blood loss, decreased postoperative pain, and lower analgesic requirements compared to traditional scalpel incisions.[6,2,7] However, some studies have raised concerns regarding wound healing, reporting a higher incidence of wound infections with electrocautery.[8,9] Historical concerns regarding tissue injury with electrocautery trace back to the early work of Peterson A in faciomaxillary surgery and Mann W in abdominal incisions, though these observations were made under strict aseptic conditions.

In the present study, a prospective randomized comparison was conducted between diathermy and scalpel skin incisions in patients undergoing elective Lichtenstein tension-free inguinal hernia repair. Our findings indicate that diathermy incisions were associated with a significantly shorter incision time compared to scalpel incisions (44.94 ± 5.20 s vs. 43.82 ± 5.45 s, p < 0.001). Early postoperative pain, assessed at 6, 12, and 24 hours using the Visual Analogue Scale (VAS), was consistently lower in the diathermy group, with all differences being statistically significant (p < 0.001). All wound complications were Type 1 Southhampton Wound surgical site infection and were managed conservatively and patient improved.

Importantly, there were no significant differences between the two groups in terms of postoperative wound complications, wound healing, or infection rates. Gender and age distribution were also comparable between groups, indicating that the observed outcomes were unlikely influenced by demographic variables. These findings suggest that while diathermy may reduce early postoperative pain and operative time, it does not adversely affect wound healing or increase complication rates.

Overall, our results align with previous studies demonstrating the efficacy of diathermy in reducing incision time and early postoperative pain without compromising wound integrity.[6,2,7] Electrocautery can therefore be considered a safe and effective alternative to scalpel incisions for inguinal hernia repair.

CONCLUSION

Diathermy is a safe and effective alternative to scalpel incisions in elective Lichtenstein inguinal hernia repair. It significantly reduces incision time and early postoperative pain without affecting wound healing or complication rates. Electrocautery enhances patient comfort and operative efficiency while maintaining comparable surgical outcomes.

REFERENCES

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