The Role of Electrocauterization in Preventing Ganglion Recurrence: Evaluating Adjuncts to Standard Surgical Excision

BACKGROUND: Ganglion cysts are the most common soft-tissue tumors of the hand and wrist, frequently recurring after surgical excision (6%-41%). Open resection is the treatment of choice, yet significant variation persists in techniques from basic stalk resection to tissue window excision and sclerosing agents, with no established optimal approach. We investigated the efficacy of electrocauterization of cyst remnants, based on the premise that scar formation may reduce recurrence. METHODS: A retrospective cohort study analyzed 181 patients (189 cysts) undergoing open ganglion excision by 2 surgeons (2018-2024). Patients were stratified into cauterized (n = 113, 116 cysts) and non-cauterized (n = 68, 73 cysts) groups. The primary outcome was recurrence. Secondary analysis assessed combined techniques. Fisher exact test compared outcomes. RESULTS: No significant difference in recurrence was observed between groups (cauterized: 5/116, non-cauterized: 7/73). Zero recurrences occurred with cauterization plus tissue window excision (n = 31) versus 1 recurrence in non-cauterized window excisions (n = 12). Capsular closure alone had higher recurrence (6/44 vs 2/7 with cauterization). Recurrences predominantly involved dorsal cysts (69%), small size (<2 cm, 46%), and patients with manual occupations. CONCLUSION: Although statistically insignificant, cauterization showed a meaningful trend toward reduced recurrence (4.3% vs 9.5% without cauterization). For dorsal ganglions, cauterization combined with window excision may reduce recurrence, while capsular closure alone may increase risk. We hypothesize that leaving the capsular defect open may allow continuous drainage, mitigating fluid reaccumulation, whereas closure could inadvertently trap residual fluid if any cystic or valvular remnants remain. A larger study investigating window excision combined with electrocautery deserves further attention.