Comparison of three tonsillectomy techniques in children

Subaşi, Buğra; Oğhan, Fatih; Taşlı, Hamdi; Akbal, Seckin; Karaman, Nesibe Esra

doi:10.1007/s00405-020-06299-8

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…Twenty‐six studies had children only with CT/RT, 12 studies had children only with OSA/SDB, and 3 studies had patients only with ATH. The surgical technique did not impact postoperative hemorrhage rates in children with a diagnosis of CT/RT, 36,42,66,73 OSA/SDB, 31,52 or ATH 56 . Method of hemostasis did not impact postoperative bleed rates in children with a surgical indication of CT/RT 21 or OSA/SDB 27 .…”

Section: Discussionmentioning

confidence: 85%

“…Full‐text review of these 624 articles was conducted and a total of 71 articles were selected for inclusion (Figure 1). 5,6,8,16‐82 Critical appraisal of studies indicated an acceptably low risk of bias for the majority of included studies (Figure 2A and B). Potential sources of bias were most pronounced in the blinding of participants and personnel, and outcomes in the randomized studies.…”

Section: Resultsmentioning

confidence: 99%

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The Impact of Surgical Indication on Posttonsillectomy Hemorrhage: A Systematic Review and Meta‐Analysis

Gutiérrez

Shannon

Nguyen

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo investigate the impact of the surgical indication on posttonsillectomy bleed rates.Data SourcesPubMed, Scopus, CINAHL.Review MethodsA systematic review was performed searching for articles published from the date of inception to July 6, 2022. English language articles describing posttonsillectomy hemorrhage rates in pediatric patients (age ≤ 18) stratified by indication were selected for inclusion. A meta‐analysis of proportions with comparison (Δ) of weighted proportions was conducted. All studies were assessed for risk of bias.ResultsA total of 72 articles with 173,970 patients were selected for inclusion. The most common indications were chronic/recurrent tonsillitis (CT/RT), obstructive sleep apnea/sleep‐disordered breathing (OSA/SDB), and adenotonsillar hypertrophy (ATH). Posttonsillectomy hemorrhage rates for CT/RT, OSA/SDB, and ATH were 3.57%, 3.69%, and 2.72%, respectively. Patients operated on for a combination of CT/RT and OSA/SDB had a bleed rate of 5.99% which was significantly higher than those operated on for CT/RT alone (Δ2.42%, p = .0006), OSA/SDB alone (Δ2.30%, p = .0016), and ATH alone (Δ3.27%, p < .0001). Additionally, those operated on for a combination of ATH and CT/RT had a hemorrhage rate of 6.93%, significantly higher than those operated on for CT/RT alone (Δ3.36%, p = .0003), OSA/SDB alone (Δ3.01%, p = .0014), and ATH alone (Δ3.98%, p < .0001).ConclusionPatients operated on for multiple indications had significantly higher rates of posttonsillectomy hemorrhage than those operated on for a single surgical indication. Better documentation of patients with multiple indications would help further characterize the magnitude of the compounding effect described here.

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Section: Discussionmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

The Impact of Surgical Indication on Posttonsillectomy Hemorrhage: A Systematic Review and Meta‐Analysis

Gutiérrez

Shannon

Nguyen

et al. 2023

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

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“…Of these, 5 were excluded as they did not fulfil our eligibility criteria. The remaining 31 studies were included in our meta‐analysis 7,10,30–58 . Figure 1 shows both the reasons behind the exclusion of the non‐eligible studies and a flow chart of the studies' identification process.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Morbidity of Different Tonsillectomy Techniques: A Systematic Review and Network Meta‐Analysis

Russo,

Festa,

Costantino

et al. 2023

The Laryngoscope

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ObjectiveTo compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain.MethodsAn arm‐based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were postoperative bleeding incidence and mean postoperative pain score.ResultsA total of 6464 patients were included for five different interventions (cold dissection tonsillectomy; extracapsular coblation tonsillectomy; intracapsular coblation tonsillectomy [ICT]; bipolar diathermy tonsillectomy [BDT]; monopolar diathermy tonsillectomy). ICT showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean postoperative pain score (1.74 ± 0.68) with a 94.0% chance of ranking first, whereas BDT showed both the highest absolute risk of bleeding incidence (10.75%) and the highest mean postoperative pain score (5.67 ± 1.43).ConclusionsICT seems to offer better postoperative outcomes, in terms of reduced risk of bleeding and reduced pain. Further prospective studies are advised to confirm these findings.Level of EvidenceNA Laryngoscope, 2023

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“…8 Subasi et al confirmed these findings in pediatric patients; however, a meta-analysis of pediatric patients showed that coblation tonsillectomy causes less pain than CSD. 9 10 These conflicting results highlight the lack of strong evidence that coblation tonsillectomy has a positive effect on postoperative pain. 11…”

Section: Discussionmentioning

confidence: 99%

Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation

Kandemir

Pamuk²,

Özel³

et al. 2023

Int Arch Otorhinolaryngol

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Introduction Tonsillectomy is among the most common otolaryngological surgeries. Objective To evaluate and compare three tonsillectomy techniques: cold steel dissection (CSD), monopolar electrocautery (MEC), and coblation. Methods The present study retrospectively reviewed the medical records of patients who underwent tonsillectomy between January 2014 and January 2016. Postoperative visual analog scale (VAS) pain scores, analgesic use, surgical duration, time to return to normal activity, and postoperative bleeding status were noted. Results The CSD group had less analgesic use and shorter return to normal activity than the MEC group (p = 0.037 and p < 0.001, respectively). The coblation group had lower VAS pain scores than the MEC group only at 1 hour to 4 hours postsurgery (p < 0.016). The postoperative bleeding rate was similar in all groups (p = 0.096). Conclusion Cold steel dissection tonsillectomy is associated with less postoperative pain and shorter recovery than MEC. Coblation is better than MEC in terms of postoperative pain at 1 hour to 4 hours only, whereas CSD is associated with less postoperative pain than coblation at 2 days to 7 days.

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Comparison of three tonsillectomy techniques in children

Cited by 9 publications

References 17 publications

The Impact of Surgical Indication on Posttonsillectomy Hemorrhage: A Systematic Review and Meta‐Analysis

The Impact of Surgical Indication on Posttonsillectomy Hemorrhage: A Systematic Review and Meta‐Analysis

Postoperative Morbidity of Different Tonsillectomy Techniques: A Systematic Review and Network Meta‐Analysis

Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation

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