Systematic Review of Complications of Tonsillotomy versus Tonsillectomy

Acevedo, Jason L.; Shah, Rahul K.; Brietzke, Scott E.

doi:10.1177/0194599812439017

Cited by 87 publications

(69 citation statements)

References 34 publications

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“…This figure can be considered high compared with previously reported reoperation frequencies of 0% to 12%. 10,23 Possible explanations for this are the small study sample, the surgical technique, and/or that the study patients were closely followed up with PSG and revisit at the clinic 1 year postoperatively. In our current clinical practice, no such follow-up is possible.…”

Section: Discussionmentioning

confidence: 99%

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

2017

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BACKGROUND: Adenotonsillectomy (ATE) is a well-established and effective treatment of pediatric obstructive sleep apnea (OSA). In recent years, a more conservative method, adenotonsillotomy (ATT), has gained popularity because it is associated with less postoperative morbidity. Yet no previous randomized study has compared these 2 methods regarding their effectiveness in treating pediatric OSA in terms of polysomnographic data, which was the primary aim of this study. The hypothesis was that ATT is noninferior to ATE after 1 year. METHODS: Seventy-nine children, aged 2 to 6 years, with OSA (Apnea-Hypopnea Index [AHI] 5–30) were randomized to ATT (n = 40) or ATE (n = 39). Polysomnography (PSG) and questionnaire OSA-18 were assessed at baseline and 1 year postsurgery. RESULTS: Mean difference between groups in the primary outcome, change in AHI, was 0.83, 95% confidence interval –3.2 to 4.9, not exceeding the noninferiority margin of 5. After ATE, AHI decreased from median 12.7 (interquartile range 8.3–19.1) to 2.0 (1.2–3.1) and after ATT from 15.8 (8.5–21.2) to 4.0 (1.2–5.1). For both groups, significant improvements of PSG and OSA-18 questionnaire outcomes were observed, with no significant differences between groups. Five children (13%) in the ATT group needed repeated surgery for tonsil regrowth and recurrence of OSA. CONCLUSIONS: The results suggest that ATT is noninferior to ATE in treating pediatric OSA regarding PSG outcomes after 1 year. ATT could be considered an alternative to ATE for treatment of pediatric OSA. However, after ATT, there is a nonnegligible risk of recurrence of OSA, and this should be taken into account when selecting surgical method.

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Section: Discussionmentioning

confidence: 99%

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

2017

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“…Unfortunately the details of the PTB were not specified. Acevedo et al [39] found an odds ratio of PTB for tonsillotomy of 0.77 compared to tonsillectomy, with a nonsignificant difference. When poorer studies were included (nonrandomized trials, trials with larger or unspecified loss to follow-up), the difference in favor of tonsillotomy became significant.…”

Section: Surgical Technique: How Much Tonsil To Remove?mentioning

confidence: 98%

“…Recently, a meta-analysis of randomized trials [38] and a systemic review, which also included nonrandomized studies [39] , comparing tonsillotomy with traditional tonsillectomy, were published. According to Walton et al [38] in randomized trials early PTB was present in 3/699 (0.4%) tonsillotomy and 1/635 (0.16%) tonsillectomy patients, a nonsignificant difference.…”

Section: Surgical Technique: How Much Tonsil To Remove?mentioning

confidence: 99%

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Hemorrhage after Tonsillectomy: Does the Surgical Technique Really Matter?

Gysin

Dulguerov

2013

ORL

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A thorough review of the publications on surgical techniques used for tonsillectomy is provided, emphasizing randomized studies and meta-analysis. In the assessment of the data it is important to clearly define and categorize the types of posttonsillectomy bleeding (PTB), as well as the various factors that have been associated with increased PTB. In recent audits of a large number of tonsillectomies, the PTB rates seem to concur: 1% early and 2.5% delayed PTB; 10% anamnestic, 2% objective, and 2% re-operation PTB. Objective PTB rates beyond 10% should require an audit. The bipolar technique seems associated with the least early PTB, while the cold technique is associated with the least delayed PTB. Because of the lack of large well-conducted randomized trials, it is difficult to conclude which technique is the best. With electrocautery techniques, the current power should be adjusted to the minimal level providing hemostasis. Surgical techniques for tonsillectomy that should probably be abandoned include monopolar electrocautery, Coblation, various lasers, and the harmonic scalpel. Vesselsealing systems might hold promise and deserve further evaluation. Tonsillotomy might be associated with less postoperative pain, but the hemorrhagic advantage in randomized studies is not obvious. Tonsil regrowth rates and efficacy to treat obstruction need also further evaluation.

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“…Walton found the new technique to be superior in recovery-related outcome compared to TE, but Acevedo could not identify any advantages in terms of postoperative bleeding and dehydration. In the light of the selected studies discussed by Acevedo et al [19] and Walton et al [20] (Tables 1, 2), the question of standardization raises several points. It should also be clarified whether the more sophisticated approaches for intratonsillar surgery can be replaced by simplified procedures.…”

Section: Introductionmentioning

confidence: 99%