Diathermy versus Scalpel in transverse abdominal incision in women undergoing repeated cesarean section in Ain Shams Maternity Hospital

Abstract

Ascalpel is an extremely sharp knife used for surgery and anatomical dissecation (Nataraj., 2010). The electrosurgery often referred to as surgical diathermy (Johnson et al., 1997). Surgical diathermy was introduced at the beginning of the 20 th century to obviate the inherent disadvantages of steel scalpel, i.e. lack of hemostasis; indistinct tissue planes; increased operative time; use of foreign material (ligature) in the wound, leading to infection risk; possibility of accidental injury in the operations theater (Kumar et al., 2011). Basic scalpel design has remained almost the same but there have been substantial improvements in the electrosurgical instruments (Duxbury et al., 2003), being haemostatic and convenient (Sheikh., 2004). With increased incidence of blood transmitted disease such as Hepatitis B, Hepatitis C and Human immunodeficiency Virus (HIV) (Arsalan et al., 2011).The risk of transmission to both doctor and patient is quite significan, Thereby avoiding and possibly even completely replacing the scalpel from operative fields looks an attractive option (Chrysos et al., 2005). Electrocautery is often available in all operation theatres however it has been used less frequently because of fear of tissue damage leading to more postoperative pain, impaired wound healing, and hypertrophic scaring (Dixon and Watkin., 1990). There are variable tissue effects such as cutting (also called vaporization), fulguration (also called superficial coagulation or spray coagulation), and desiccation (also called deep coagulation) (Redwine., 1992). Many studies are conducted to compare electrocautery incision with scalpel incision over skin and many of them showed electrocautery incision is better than scalpel incision in terms of time taken for incision, lesser pain, better wound healing and little blood loss (Kerans et al., 2001 and Pollinger et al., 2003)

Cesarean section is the commonest major operation performed on women worldwide (Hofmeyr et al., 2008) Operative techniques used for caesarean section vary and some of these techniques have been evaluated through randomised trials (Mathai and Hofmeyr., 2007). However there is no study comparing the scalpel incision versus electrocautery in cesarean section, so it was plausible to study this comparison.