Sofia Kordeluk1, Aviv Goldbart2, Lena Novack3, Daniel Michael Kaplan4, Sabri El-Saied4, Musa Alwalidi4, Angelica Shapira-Parra4, Nili Segal4, Yuval Slovik4, Puterman Max4, Ben-Zion Joshua4. 1. Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel. artur33@012.net.il. 2. Department of Pediatrics and Sleep-Wake Disorders Unit, Soroka University Medical Center, Beersheva, Israel. 3. Department of Public Health, Faculty of Medical Sciences, Ben-Gurion University in the Negev, Beersheva, Israel. 4. Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center, Box 151, 84101, Beersheva, Israel.
Abstract
To determine if there was a difference in the inflammatory reaction after tonsil surgery with "traditional" techniques (tonsillectomy and adenoidectomy or TA) compared to partial intracapsular tonsillectomy and adenoidectomy (PITA). DESIGN: Randomized, double-blind study. SETTING: tertiary care academic hospital. Children under the age of 16 years with a diagnosis of obstructive sleep disordered breathing were randomly allocated into three study groups: TA with electrocautery (n = 34), PITA with CO2 laser (n = 30) and PITA with debrider (n = 28). All of the children underwent adenoidectomy with a current at the same surgical procedure. MAIN OUTCOME MEASURE: c-reactive protein level (CRP) was the primary endpoint. In addition, the following were assessed: white blood cells (WBC), neutrophils (NEU), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Pre- and post-procedure measurements were compared between the groups. Parents filled out a questionnaire daily during the first postoperative week assessing pain, swallowing and snoring. CRP levels ascended higher in the PITA groups after surgery (p = 0.023), WBC and NEU showed the same pattern, IL-6 levels were higher in PITA group and there was no difference in TNF-alpha levels between the two types of procedures. Postoperative pain and postoperative hemorrhage were significantly lower in the PITA groups as compared to the TA group (p = 0.01 and 0.048). PITA in comparison to TA is associated with lower morbidity; however, the inflammatory response does not differ significantly in the first 24 h after surgery. Additional long-term studies assessing efficacy of PITA are warranted. LEVEL OF EVIDENCE: Level 1, prospective randomized controlled trial.
RCT Entities:
To determine if there was a difference in the inflammatory reaction after tonsil surgery with "traditional" techniques (tonsillectomy and adenoidectomy or TA) compared to partial intracapsular tonsillectomy and adenoidectomy (PITA). DESIGN: Randomized, double-blind study. SETTING: tertiary care academic hospital. Children under the age of 16 years with a diagnosis of obstructive sleep disordered breathing were randomly allocated into three study groups: TA with electrocautery (n = 34), PITA with CO2 laser (n = 30) and PITA with debrider (n = 28). All of the children underwent adenoidectomy with a current at the same surgical procedure. MAIN OUTCOME MEASURE: c-reactive protein level (CRP) was the primary endpoint. In addition, the following were assessed: white blood cells (WBC), neutrophils (NEU), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Pre- and post-procedure measurements were compared between the groups. Parents filled out a questionnaire daily during the first postoperative week assessing pain, swallowing and snoring. CRP levels ascended higher in the PITA groups after surgery (p = 0.023), WBC and NEU showed the same pattern, IL-6 levels were higher in PITA group and there was no difference in TNF-alpha levels between the two types of procedures. Postoperative pain and postoperative hemorrhage were significantly lower in the PITA groups as compared to the TA group (p = 0.01 and 0.048). PITA in comparison to TA is associated with lower morbidity; however, the inflammatory response does not differ significantly in the first 24 h after surgery. Additional long-term studies assessing efficacy of PITA are warranted. LEVEL OF EVIDENCE: Level 1, prospective randomized controlled trial.
Authors: L Stiller-Timor; A D Goldbart; N Segal; A Amash; M Huleihel; A Leiberman; A Tal; G Holcberg; M Puterman Journal: Int J Pediatr Otorhinolaryngol Date: 2012-01-23 Impact factor: 1.675
Authors: Peter J Koltai; C Arturo Solares; Jeffery A Koempel; Keiko Hirose; Tom I Abelson; Paul R Krakovitz; James Chan; Meng Xu; Edward J Mascha Journal: Otolaryngol Head Neck Surg Date: 2003-11 Impact factor: 5.591
Authors: David O Francis; Christopher Fonnesbeck; Nila Sathe; Melissa McPheeters; Shanthi Krishnaswami; Sivakumar Chinnadurai Journal: Otolaryngol Head Neck Surg Date: 2017-01-17 Impact factor: 3.497