400 A Comparative Study of Intracapsular & Extracapsular Coblation Paediatric Tonsillectomy in A Tertiary Centre

Abstract

Abstract Background Intracapsular tonsillectomy has emerged as a novel alternative to traditional tonsillectomy where the tonsillar capsule is left intact with a small amount of overlying tonsillar tissue. There is growing evidence to suggest that intracapsular tonsillectomy is associated with reduced post-operative pain, haemorrhage and readmission rates. The aim of this study was to assess the reported benefits of intracapsular tonsillectomy within the ENT department at a tertiary paediatric hospital. Method Retrospective analysis comparing two cohorts of 72 consecutive paediatric patients undergoing coblation intracapsular and extracapsular tonsillectomy between March-2019 and November-2020. Patient age at procedure, removal of adenoids, indication, surgeon grade, and discharge time were recorded. Post-tonsillectomy bleeding and 30-day readmission rates were used as the main outcome measures. Results The median age in both groups was 5 years. The intracapsular cohort demonstrated a lower 30-day readmission rate (8.3% vs. 15.3%), lower primary (<24 hours) post-op bleed rate (0% vs. 2.78%) and lower secondary (>24hours) post-op bleed rate (4.2% vs. 12.5%) when compared to the extracapsular cohort. Eight cases were conducted as day cases in total, all Intracapsular, with none of these patients requiring readmission within 30 days. Discussion Coblation Intracapsular tonsillectomy is an effective and low-risk alternative to extracapsular techniques. It is hoped with the reduced associated risks and morbidity associated with the procedure, the department can move towards day case tonsillectomy procedures resulting in a reduction in overall healthcare costs and improved patient experience.