Source: DGNews  |  Posted 1 year ago

ALEXANDRIA, Va -- June 3, 2010 -- In a review of 3 different surgical techniques commonly used for tonsillectomy, the microdebrider technique had the lowest overall complication rate when compared with the other 2 techniques. The results are published in the June 2010 issue of Otolaryngology -- Head and Neck Surgery.

Despite the frequency of tonsillectomy, there is no universally accepted ideal method. And although generally considered a safe procedure, tonsillectomy has significant potential for complications, especially in the paediatric population. Potential major complications include post-operative haemorrhage, dehydration, and anaesthetic and airway risks. Common post-operative complaints like odynophagia, otalgia, fever, and uvular swelling tend to prolong the paediatric patient's recovery.

The objective of the study was to determine if surgical technique is associated with a patient experiencing post-surgical complications after undergoing adenotonsillectomy, and to identify patients who may be at high risk for major complications after such surgery.

The case-controlled study included 4,776 patients aged 1 to 18 years undergoing adenoidectomy, tonsillectomy, or adenotonsillectomy over a 36-month period. The 3 techniques compared were microdebrider, coblation or electrocautery.

Results showed a statistically significant difference in the risks of developing a major complication of having a tonsillectomy with coblation, electrocautery, or microdebrider.

The microdebrider had the lowest overall complication rate of 0.7% versus that of the coblator (2.8%) and electrocautery (3.1%).

The authors reported that those who had tonsillectomies via coblation were 3.9 times more likely to have complications than those who had tonsils removed via microdebrider. In addition, complications for patients who had tonsillectomies via electrocautery were 4.4 times more likely than those who had tonsils removed via microdebrider.

"Questions will remain regarding what is the best procedure," said study author Craig S. Derkay, MD, Children's Hospital of The King's Daughters, Norfolk, Virginia. "However, an important point is that that no matter which surgical technique was used for removal of the tonsils in the study, our results demonstrate an acceptable level of safety across all procedures."

In terms of risk factors for post-surgical complications, patient's age proved to be a significant aspect in their treatment and outcome following tonsillectomy. When looking at the average age of dehydration and post-tonsillectomy haemorrhage, the authors observed that the younger patients had more episodes of dehydration, while older patients tend to have more episodes of post-tonsillectomy haemorrhage.

The authors urge continued study in the area of adenotonsillectomy surgical techniques, but noted that the large cohort of patients in their study adds to the literature supporting the safety of intracapsular tonsillectomy.

SOURCE: American Academy of Otolaryngology -- Head and Neck Surgery