BACKGROUND: The cold scalpel is more widely used than diathermy for skin incisions and there are numerous debates on a better alternative.This study compared the duration of operation, cosmetic outcome and local wound complications between groin skin incisions made with cold scalpel and those made with cutting diathermy in paediatric patients. METHODOLOGY: One hundred patients with110 inguinal hernias, hydroceles and undescended testes booked for elective groin operations were enrolled, operated on and followed up. They were randomised into two groups with 55 groin operations in each group; one group had cold scalpel skin incisions and the other cutting diathermy skin incisions. The duration of operation was recorded; the cosmetic outcome measured with the Visual analogue scale (VAS) and modified Vancouver scar scales (mVSS) and local wound complications were recorded at 1 week and 1 month post operation and data were analysed. RESULTS: Duration of operation was 36.07± 15.69 and 35.55± 13.87 minutes in the cold scalpel and diathermy groups respectively (p = 0.957).The mean VAS score was 8.14 ± 1.241 in the cold scalpel group and 8.64 ± 1.095 in the diathermy groupat 1 week and8.79 ± 0.815and 9.13 ± 0.771in the cold scalpel and diathermy groups respectively at 1 month. The mean mVSS score was3.65 ± 1.280 in the cold scalpel group and 2.91 ± 1.127 in the diathermy group at 1 week and2.05 ± 1.311 and 1.76 ± 1.036 in thescalpel anddiathermy groups respectively at 1 month.Diathermy scars had significantly better scores for the VAS at 1 week (p=0.027)and 1 month (p=0.028) and mVSS at 1 week (p=0.002).There was no significant difference in mVSS scores at 1 month (p=0.199). Seroma occurred in 5.5% and 1.8% (p=0.618); hematoma in 1.8% and 0.0% (p= 1.000) and wound dehiscence in 1.8% and 5.5% (p = 0.618)of the cold scalpel and diathermy skin incisions respectively. CONCLUSION: Diathermy skin incisions are safe and produce a scar with a comparable cosmetic outcome to cold scalpel skin incisions.