Complications in Tonsillotomy: A Systematic Review

Abstract

Objective: Intracapsular tonsillectomy (or tonsillotomy) is a technique rapidly gaining acceptance. Multiple individual clinical trials have been performed, but there remains no clear consensus as to how tonsillotomy compares to traditional methods in regard to complication rates. The purpose of this study is to compile and critically analyze this data. Method: MEDLINE was searched using multiple search terms, with the following inclusion criteria: English language, human subjects, and related to complications of tonsillotomy. Multiple tonsillotomy techniques were included. The results of these studies were summated, and the results were analyzed. Random effects modeling was used to calculate summary effect measures. Results: Thirty-three studies met inclusion criteria. The bleeding rate for tonsillectomy was 3.4% ( P < .01, 95% CI=0.027-0.041, k=23) with a dehydration re-visit rate of 3.4% (<0.01, 0.018-0.049, 13). For tonsillotomy, the rates were 1.5% (<0.01, 0.012-0.017, 31) and 1.4% (<0.01, 0.006-0.022, 17), respectively. When stratifying for tonsillotomy technique, the rates were 1.5% (<0.01, 0.014-0.017, 5) and 1.5% (<0.01, 0.014-0.017, 4) for coblation and 0.8% (<0.01, 0.006-0.01, 15) and 1.7% (<0.01, 0.007-0.026, 10) for microdebrider. Number of days receiving analgesia was 7.045 (<0.01, 6.31-7.76, 5) for tonsillectomy and 4.09 (3.19-4.99, 7) for tonsillotomy. There was no difference in blood loss between groups. Conclusion: Tonsillotomy appears to compare favorably with tonsillectomy and may offer a reduction in postoperative complications (bleeding and dehydration), as well as less use of analgesics. Subgroup analysis suggests that microdebrider tonsillotomy may have a lower bleeding rate than the coblation technique.