Revision adenoidectomy in children: a meta-analysis

Abstract

Background:To estimate the rate of revision surgery after previous adenoidectomy in children and to compare the rate of revision adenoidectomy in children with different conditions and by using different surgical techniques. Methodology:The study protocol was registered on PROSPERO (CRD42018107877). Two authors independently searched databases, specifically PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords used were "adenoids, " "adenoidectomy, " "reoperation, " "revision, " and "regrowth. " The revision rate was pooled using a random-effect model. Subgroup analyses were conducted for children based on different settings, countries, risks of bias, and surgical techniques. Results:A total 16 studies with 95 727 children were analyzed (mean age: 4.69 (1.62) years; 60% boys; sample size: 5983 patients).Five studies had a low risk of bias, 10 studies had a moderate risk of bias, and one study had a high risk of bias. The rate of revision adenoidectomy was 1.9%. Ages at initial surgery and follow-up were not significantly associated with revision surgeries. The revision rate was not significantly different in children receiving surgeries in different settings (single center vs multicenter vs population-based, country (non-United States vs United States, and risk of bias. Moreover, surgical techniques, such as curettage, suction cautery, microdebridement, and coblation did not significantly affect revision rates in children who received adenoidectomy. Conclusions:Revision surgery was undertaken with a frequency of 1.9% in children who underwent adenoidectomy. A lack of strong evidence exists to correlate surgical techniques with revision rate in pediatric adenoidectomy.

Prevalence of Revision Adenoidectomy in a Tertiary Otorhinolaryngology Centre in Nigeria

“…[ 8 11 12 13 14 16 ] Population-based prevalence is however reported to range from 2.6% to 9.8%. [ 5 17 ] A recent meta-analysis of revision adenoidectomy that included both hospital- and population-based studies has put the overall prevalence at 1%–2%,[ 18 ] which is in keeping with our findings.…”

“…The mean age at the second surgery (5.8 ± 3.4 years) is similar to the mean age reported for a single-staged adenoidectomy. [ 18 ] This age coincides with the age at which adenoid growth reaches a peak and then begins to regress. [ 4 21 ] Although 18 (69%) of the cases had primary surgery within the first 2 years of life, 97% of the control had their adenoidectomies between 3 and 6 years of life.…”

“…Other studies found a higher mean age. [ 8 13 18 19 ] Age < 2 years at primary surgery has been reported to increase the likelihood of a revision adenoidectomy. [ 20 ] Because of the high prevalence of recurrent upper respiratory tract infections (URTI) in children <2 years, which in turn has been found to stimulate adenoid growth,[ 21 22 ] it then means that removing the adenoids at such an early age could pose a risk for adenoid regrowth, which may be significant enough to cause symptoms that will necessitate a revision surgery.…”

“…Although we could not find a definite explanation for the higher rate of revision surgery in males, it is likely that our small sample size might have contributed to this discrepancy. There have been conflicting reports on the sex distribution of revision adenoidectomy, with some studies reporting higher rates in males,[ 5 18 ] and others higher rate in females. [ 19 ]…”

Nasal Polyps in Children: The Early Origins of a Challenging Adulthood Condition

“…As a matter of fact, they are widely and effectively used in children with AR, confirming that the systemic bioavailability of second-generation compounds, such as mometasone and fluticasone, is less than 1%, making them safe for long-term use [84]. In younger children refractory to appropriate medical therapy, adenoidectomy is considered the first-line surgical intervention [1,28,85], followed by functional endoscopic sinus surgery aimed at reestablishing adequate sinus ventilation and secretion drainage [86,87].…”