J P Windfuhr1. 1. Klinik für HNO-Krankheiten; Kopf-, Hals- und Plastische Gesichtschirurgie, Malteser Krankenhaus St. Anna, Duisburg. jochen.windfuhr@malteser.de
Abstract
BACKGROUND: Controversy surrounds the question of which technique should be preferred for tonsillectomy in order to reduce postoperative morbidity in terms of pain, bleeding, activity and return to normal diet. This study reviews the current literature on coblation tonsillectomy (CTE). MATERIALS AND METHODS: All studies published in peer-reviewed journals reporting postoperative morbidity following CTE until July 2006 were included in our study. RESULTS: A total of 21 studies matched our search criteria but there were excluded from further analysis because coblation was used only for volume reduction of the tonsils. Reduced morbidity was registered in eight studies, two could not identify any difference and five studies reported an increased postoperative morbidity. Seven different surgical procedures were compared in 17 studies to CTE. The patients were not followed-up in four studies and the follow-up exceeded 1 week in nine studies only. Wound inspection was performed in four studies and a better wound healing reported in two of these, but by the same authors. Postoperative bleeding requiring surgical treatment under general anaesthesia occurred with an incidence of 0% to 11.5%. Secondary bleeding (>24 h) prevailed in all but two studies. Postoperative pain was evaluated in ten studies with conflicting results. CONCLUSIONS: The design of the current studies varies in size, age distribution, indications for surgery, the surgical techniques compared and follow-up. The results are heterogenous and further evidence is still required to show that CTE is a safe alternative. Therefore, calculation of cost-effectiveness of a commonly performed expensive CTE as a new standard technique is currently impossible.
BACKGROUND: Controversy surrounds the question of which technique should be preferred for tonsillectomy in order to reduce postoperative morbidity in terms of pain, bleeding, activity and return to normal diet. This study reviews the current literature on coblation tonsillectomy (CTE). MATERIALS AND METHODS: All studies published in peer-reviewed journals reporting postoperative morbidity following CTE until July 2006 were included in our study. RESULTS: A total of 21 studies matched our search criteria but there were excluded from further analysis because coblation was used only for volume reduction of the tonsils. Reduced morbidity was registered in eight studies, two could not identify any difference and five studies reported an increased postoperative morbidity. Seven different surgical procedures were compared in 17 studies to CTE. The patients were not followed-up in four studies and the follow-up exceeded 1 week in nine studies only. Wound inspection was performed in four studies and a better wound healing reported in two of these, but by the same authors. Postoperative bleeding requiring surgical treatment under general anaesthesia occurred with an incidence of 0% to 11.5%. Secondary bleeding (>24 h) prevailed in all but two studies. Postoperative pain was evaluated in ten studies with conflicting results. CONCLUSIONS: The design of the current studies varies in size, age distribution, indications for surgery, the surgical techniques compared and follow-up. The results are heterogenous and further evidence is still required to show that CTE is a safe alternative. Therefore, calculation of cost-effectiveness of a commonly performed expensive CTE as a new standard technique is currently impossible.
Authors: Kelvin C Lee; Mark M Altenau; David R Barnes; Joseph M Bernstein; Nadim B Bikhazi; Frank A Brettscheider; Charles H Caplan; William A Ditkowsky; Craig F Ingber; Lee M Klausner; Maseih M Moghaddassi Journal: Otolaryngol Head Neck Surg Date: 2002-12 Impact factor: 3.497