Dimitrios Daskalakis1,2, Nikolaos Tsetsos3, Stella Karagergou4, John Goudakos5, Konstantinos Markou6, Peter Karkos7. 1. Department of Otorhinolaryngology-Head and Neck Surgery, York Teaching Hospital, York, UK. d_daskalakis@yahoo.gr. 2. Department of Otorhinolaryngology-Head and Neck Surgery, G. Gennimatas General Hospital, Thessaloniki, Greece. d_daskalakis@yahoo.gr. 3. Department of Otorhinolaryngology-Head and Neck Surgery, George Papanikolaou General Hospital, Thessaloniki, Greece. 4. Private Practice, Thessaloniki, Greece. 5. Department of Otorhinolaryngology-Head and Neck Surgery, Army General Hospital, 424, Thessaloniki, Greece. 6. 2nd Academic Otorhinolaryngology-Head and Neck Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece. 7. 1st Academic Otorhinolaryngology-Head and Neck Surgery Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
Abstract
PURPOSE: To assess all available data regarding the comparative benefit of intracapsular coblation tonsillectomy (ICT) versus extracapsular coblation tonsillectomy (ECT) in children. METHODS: MEDLINE, the Cochrane Library and Springerlink databases as well as other sources were searched by two independent reviewers. Controlled studies comparing ICT versus ECT in paediatric patients with obstructive sleep apnea (OSA) or recurrent tonsillitis were included. Overall postoperative pain was the primary outcome. Secondary outcomes were postoperative hemorrhage, diet and activity, duration of operation and tonsillar regrowth. In case of homogenous, processable data (I2 < 60%), a meta-analysis was performed. RESULTS: Six studies met the inclusion criteria. The analysis showed significant difference between the two methods in terms of late postoperative pain with the ICT being less painful (SMD - 0.78, 95% CI [- 1.03, - 0.53]). However, there was no significant difference in early postoperative pain (≤ 48 h) between the two techniques (SMD - 0.18, 95% CI [- 0.47, 0.12]). All the rest of the secondary outcomes are presented in a qualitative synthesis due to published data limitations of the included studies. CONCLUSION: Intracapsular coblation tonsillectomy appears to be a less painful operation in comparison to extracapsular coblation tonsillectomy. This seems to occur due to prevention of late pain flare up that normally happens several days after the procedure (described as postoperative dip) and not due to reduced pain at the immediate postoperative period. However, as all studies published are small sized, high-quality, large-sample studies need to be performed in the future for more concrete conclusions.
PURPOSE: To assess all available data regarding the comparative benefit of intracapsular coblation tonsillectomy (ICT) versus extracapsular coblation tonsillectomy (ECT) in children. METHODS: MEDLINE, the Cochrane Library and Springerlink databases as well as other sources were searched by two independent reviewers. Controlled studies comparing ICT versus ECT in paediatric patients with obstructive sleep apnea (OSA) or recurrent tonsillitis were included. Overall postoperative pain was the primary outcome. Secondary outcomes were postoperative hemorrhage, diet and activity, duration of operation and tonsillar regrowth. In case of homogenous, processable data (I2 < 60%), a meta-analysis was performed. RESULTS: Six studies met the inclusion criteria. The analysis showed significant difference between the two methods in terms of late postoperative pain with the ICT being less painful (SMD - 0.78, 95% CI [- 1.03, - 0.53]). However, there was no significant difference in early postoperative pain (≤ 48 h) between the two techniques (SMD - 0.18, 95% CI [- 0.47, 0.12]). All the rest of the secondary outcomes are presented in a qualitative synthesis due to published data limitations of the included studies. CONCLUSION: Intracapsular coblation tonsillectomy appears to be a less painful operation in comparison to extracapsular coblation tonsillectomy. This seems to occur due to prevention of late pain flare up that normally happens several days after the procedure (described as postoperative dip) and not due to reduced pain at the immediate postoperative period. However, as all studies published are small sized, high-quality, large-sample studies need to be performed in the future for more concrete conclusions.
Authors: A W Hoey; N M Foden; S Hadjisymeou Andreou; F Noonan; A K Chowdhury; S R Greig; E L Sproson; D Allin; N Amin; K M Wouters; N E Jonas; D J Tweedie Journal: Clin Otolaryngol Date: 2017-03-19 Impact factor: 2.597
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