Six RCTs (1,234 patients; sample size 38 to 369) were included in the review. Five trials were rated as having a low risk of bias. All except one trial reported adequate randomisation. Half of the trials met the criteria for allocation concealment and blinding. Four trials reported adequate follow-up.
There was no statistically significant difference between the surgical skin incision techniques in the pooled analysis for infection rate (five RCTs; heterogeneity not reported). There was no evidence of publication bias. A pooled result was not possible for wound cosmesis, as only one trial reported results for this outcome. In this trial, the difference between techniques was not statistically significant.
A statistically significant outcome for incision time favoured electrocautery over scalpel use (WMD -28.56 seconds, 95% CI -48.35 to -8.76; two RCTs; significant heterogeneity).
There was a trend in favour of electrocautery for lower incisional blood loss, but the pooled analysis failed to reach statistical significance (three RCTs; significant heterogeneity).
There was a trend favouring electrocautery for less postoperative incisional pain, but meta-analysis could not be carried out.