Abstract
Objectives Adenotonsillectomy (AT) is amongst the most widely performed pediatric surgeries in the United States (US) and the whole world. AT includes two major surgical techniques: total tonsillectomy (TT) and partial tonsillectomy (PT). Several studies have been conducted to evaluate the difference between TT and PT and assess the comparative effectiveness, benefits, and sequelae between both. In Lebanon, very few studies were done tackling this issue and assessing its sequelae on the pediatric population. Methods A prospective study was conducted including pediatric patients aged between 2 and 9 years, who were admitted for partial tonsillectomy (PT) or total tonsillectomy (TT) in 2018. An estimated number of children included were 50: 25 patients underwent PT and 25 patients underwent TT. Patients were sent home on day 1 post-op with a questionnaire that evaluates the following over the first 10 days post-op: pain using the Wong–Baker Faces Pain Rating Scale and the “Parents Postoperative Pain Measure” (PPPM) questionnaire, and appetite using the visual analogue scale (VAS). Results Patients in the PT group and in the TT group had no demographical differences in terms of age, BMI, exposure to smoking, area of living, and attending a day care center. Comparison between PT and TT revealed a significant difference in both pain and appetite scales. Patients who underwent PT had significantly lower PPPM scores on the 1st, 2nd, 4th, 5th, 6th, and 10th day after surgery compared to the TT patients. Further validation was revealed by the Wong–Baker Faces Pain Rating Scale, showing that the PT surgery group experienced significantly less postoperative pain compared to the TT surgery group. Assessing the appetite using the visual analogue scale favored PT over TT. Comparisons revealed that most PT patients returned to their normal eating habits starting at day 4 while this was applicable in the TT group at day 10. Postoperative pain improved from day 1 to day 10 in both surgical groups. Conclusion In conclusion, the recovery process after the PT surgery causes less postoperative morbidity, thus an earlier return to normal activity compared to the TT. The patients of the latter group are affected by more pain and less appetite over the first 10 days after the surgery.
Highlights
In the first century BC, Aulus Cornelius Celsus, a Roman physician, was the first to describe the surgical removal of tonsils by applying vinegar and milk to ensure hemostasis at the surgical site
Complications associated with total tonsillectomy, such as pain, bleeding, and eating difficulties, have led surgeons to consider partial tonsillectomy, which was introduced by Philip Physick using the tonsil guillotine during the procedure. is surgery was more common until 1930s, but was International Journal of Otolaryngology replaced by total tonsillectomy for fear of regrowth and recurrence of symptoms and sometimes tonsillitis of the residual tonsillar tissue [2]
partial tonsillectomy (PT) was associated with a decrease in emotional distress and activity limitations [4], but accompanied with tonsillar regrowth (6%) and symptom recurrence compared to total tonsillectomy without statistically significant difference in the long run [3]
Summary
Adenotonsillectomy (AT) is amongst the most widely performed pediatric surgeries in the United States (US) and the whole world. Several studies have been conducted to evaluate the difference between TT and PT and assess the comparative effectiveness, benefits, and sequelae between both. A prospective study was conducted including pediatric patients aged between 2 and 9 years, who were admitted for partial tonsillectomy (PT) or total tonsillectomy (TT) in 2018. Comparison between PT and TT revealed a significant difference in both pain and appetite scales. Further validation was revealed by the Wong–Baker Faces Pain Rating Scale, showing that the PT surgery group experienced significantly less postoperative pain compared to the TT surgery group. The recovery process after the PT surgery causes less postoperative morbidity, an earlier return to normal activity compared to the TT. E patients of the latter group are affected by more pain and less appetite over the first 10 days after the surgery The recovery process after the PT surgery causes less postoperative morbidity, an earlier return to normal activity compared to the TT. e patients of the latter group are affected by more pain and less appetite over the first 10 days after the surgery
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