A single blind controlled study comparing bipolar elecrocautery tonsillectomy to cold dissection method in pediatric age groups

Abstract

Background: Tonsillectomy is one of the most commonly performed operations in otolaryngology. There are many proven methods of tonsillectomy, including cold dissection and bipolar electrocautery. Objective: To compare bipolar elecrocautery tonsillectomy with cold dissection method in pediatric age groups. Methods: Single blind controlled study to compare bipolar technique against the conventional dissection/snare technique. Results: The average amount of bleeding on electrocautery side was 4.07ml and on the cold dissection side was 14.58 ml. The mean time of operation for electrocautery and cold dissection was 12.04 and 16.57 minutes respectively. On the second post operative day, 35% of the patients complained of pain on the cauterized side, 30% complained of more pain on the dissection side while 35 % experienced equal pain on both sides. Post-operative complication such as hemorrhage was not seen in both the techniques employed. Conclusion: In the present study, bipolar diathermy tonsillectomy had advantages in having less post-operative time and blood loss intraoperatively but patients experience slightly more pain than cold dissection.

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

“…8–15,19,20,23,25,27,33–41,43–47,50–59,62–64,67,70–79,81–84,88,89,91,92,94–98,101,102,106–108,177 The 6299 children across studies who were treated with total tonsillectomy experienced 265 episodes (4.2%) of PTH (Table 2). PTH ranged from parent-reported bleeding that did not require accessing clinical care to reoperation for hemostasis.…”

“… † References 8-15, 19, 20, 23, 25, 27, 33-41, 43-47, 50-59, 62-64, 67, 70-79, 81-84, 88, 89, 91, 92, 94-98, 101, 102, 106-108, 177 …”

Effect of modified bipolar tonsillectomy on postoperative pain

“…The cold dissection tonsillectomy is a traditional technique of surgery, meanwhile, monopolar electrocautery tonsillectomy is a preferred technique, but it is associated with more pain and slower healing [2,20]. Bipolar electrocautery is preferred over monopolar cautery for tonsillectomy because the spread of heat is less and more controlled and consequently the tissue damage and postoperative pain are reduced [3,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Several studies support the hypothesis that the extent of diathermy used in tonsillectomy has a direct influence on the delayed postoperative morbidity and healing of the mucosal wounds [1].…”

“…However, to date none of the commonly used techniques has been shown to be superior. Attempts are made to find an ideal surgical method with shorter operative time, less intraoperative blood loss, quick recovery, and less pain [15,[26][27][28][29][30][31][32][33][34][35][36][37][38]. Despite the frequency of tonsillectomy, not universally accepted "ideal" method is discovered yet [39].…”

“…In Ali et al 's [31] study, although, the initial postoperative pain was not different statistically between BET and CDT groups, later, on 7th and 14th days after surgery, the severity of pain was significantly higher in patients who underwent tonsillectomy with BET. In studies carried out by Chettri et al [32,33], Adoga [34] and Bukhari et al [35] a significantly greater percentage of patients in the BET group complained of higher pain intensity than the CDT group. Vithayathil et al [36] and Hashemi et al [37] showed no significant difference between two studied groups BET and CDT [39,40].…”