Comparison of three techniques in pediatric tonsillectomy

Abstract

The objective of this study was to compare the thermal welding technique (TWT), classic dissection (CD) tonsillectomy and bipolar cautery dissection (BCD) for pediatric tonsillectomy. Three hundred and five consecutive children with chronic tonsillitis and/or upper airway obstruction were alternately assigned to the TWT, CD, or BCD tonsillectomy groups. Age, gender, operation time, intraoperative blood loss, early postoperative pain, time to regain normal diet, and extent of healing of the tonsillar fossa on the tenth postoperative day were evaluated. The rate of intraoperative blood loss was significantly lower in the thermal welding and BCD groups (p < 0.001). The difference between mean operative time of TWT and BCD groups was not statistically significant (p > 0.001). The difference between mean operative time of the two groups against cold dissection group was statistically significant (p < 0.001). No significant difference was found in the incidence of posttonsillectomy hemorrhage between the three patient groups (p > 0.001). The mean pain score was 4.8 ± 1.2 (median 5, range 4-6) in the TWT group, 8.3 ± 1.3 (median 8, range 7-10) in the BCD group, and 5.1 ± 1.2 (median 5, range 4-7) in the CD group 6 h to 7 days post-surgery. The difference between mean pain score between TWT and CD was not statistically significant (p > 0.001). The difference between mean pain score of the two groups against BCD group was statistically significant (p < 0.001). The results showed TWT as a new tonsillectomy technique with advantages such as shorter operation time and minimal intraoperative blood loss for children patient's post operative comfort. When we compared TWT with the cold dissection and bipolar cautery tonsillectomy, we found that TWT tonsillectomy offered an innovative new tonsillectomy method with significantly reduced blood loss and reduced surgical time and without any increase in the postoperative pain.