Tonsillectomy Outcomes for Coblation Versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis.

Abdulmalik Alsaif,Mohammad Alazemi,Narvair Kahlar,Abdulrahman Al-Naseem,Abdulredha Al Muhanna,Ahmad Abul,Mohammad Karam,Turki Aldrees

doi:10.1177/0145561321994995

Abstract

There is no consensus on the optimal tonsillectomy technique in adult patients. The study aims to identify all studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary outcomes were hemorrhage and postoperative pain. Secondary outcome measures included return to theatre, analgesia, intraoperative bleeding, diet, tonsillar healing, and operation time. Fixed-effects modeling was used for the analysis. Six studies were identified enrolling a total of 1824 patients. There were no significant differences in terms of reactionary hemorrhage (OR = 1.81, P = .51), delayed hemorrhage (OR = 0.72, P = .20), or postoperative pain (mean difference = -0.15, P = .45); however, there is a general trend favuring coblation. For secondary outcomes, no significant differences noted in terms of intraoperative bleeding, diet, and cases returning to theatre. Analgesia administration was either insignificant or higher in the coblation group. The coblation group had longer operation time and greater healing effect on tonsillar tissue. There were no significant differences in outcomes for coblation and bipolar diathermy for adult tonsillectomy patients in this systematic review and meta-analysis.

Highlights

Introduction and AimsThere is no consensus on the optimal tonsillectomy technique in adult patients
Noon et al reported no significant difference in the number of cases that returned to the theatre between coblation and bipolar groups (4 and 0 cases, respectively)
In addition to the outcomes mentioned above, the findings of this study reported many secondary outcomes that proved coblation has very similar efficacy to bipolar diathermy for adult patients undergoing tonsillectomy

Summary

Introduction

There is no consensus on the optimal tonsillectomy technique in adult patients. The study aims to identify all studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Secondary outcome measures included return to theatre, analgesia, intraoperative bleeding, diet, tonsillar healing, and operation time. No significant differences noted in terms of intraoperative bleeding, diet, and cases returning to theatre. Conclusions: There were no significant differences in outcomes for coblation and bipolar diathermy for adult tonsillectomy patients in this systematic review and meta-analysis. Coblation involves passing radiofrequency energy through a conductive medium breaking down intracellular bonds and in effect segregates the tissue.[5] Regardless of the technique used, differences are present in complications including postoperative pain, hemorrhage, and postoperative infection. The debate about the optimal surgical technique continues in literature.[4]

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Results

Discussion

Conclusion