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Evidence summaries

Surgical Techniques for Tonsillectomy

Coblation technique may result in less pain on postoperative day 1 than other techniques, but the difference is small and may be clinically meaningless. By postoperative day 7, there may be no differences between different techniques. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 29 studies with a total of 2561 subjects. Most studies did not clearly report the participant characteristics, surgical indications or whether patients underwent tonsillectomy or adenotonsillectomy. Most studies reported that tonsillitis (infection) and/or tonsillar hypertrophy (obstruction) were the indication for surgery. The technique of tonsillectomy in the control groups varied between studies. Seven studies included only adults, 16 studies only children and 6 studies both.

  • Pain:At postoperative day 1 the patients in the coblation group had less pain (SMD -0.79, 95% CI -1.38 to -0.19; 6 studies, n=538). This effect is reduced a SMD of -0.44 (95% CI -0.97 to 0.09; 5studies, n=401) at day 3, and at day 7 there is little or no difference in pain (SMD -0.01, 95% CI -0.22 to 0.19; 5 studies, n=420). Although this suggests that pain may be slightly less in the coblation group between days 1 and 3, the clinical significance is unclear.
  • Intraoperative blood loss: The risk of primary bleeding was similar (RR 0.99, 95% CI 0.48 to 2.05; 25 studies, n=2055). The risk of secondary bleeding was greater in the coblation group (RR 1.36, 95% CI 0.95 to 1.95; 25 studies, n=2118). Using the median of the control group as the baseline risk, the absolute risk in the coblation group was 5% vs. 3.6% in the control group.
  • Secondary outcomes: It was not possible to identify the differences in the time to resumption of normal diet or activity, or in the duration of surgery.Adverse events other than bleeding were not well reported. It is unclear whether there is a difference in postoperative infections or the need for reoperation.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients, methods and outcomes) and study quality (lack of blinding).

References

  • Pynnonen M, Brinkmeier JV, Thorne MC et al. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2017;8():CD004619. [PubMed]

Primary/Secondary Keywords