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Dissection versus diathermy for tonsillectomy.
1St Michael's Hospital Bristol, United Bristol Healthcare Trust, St Michael's Hill, Bristol, UK, BS2 8EG. darrenpinder@lineone.net
The Cochrane Database of Systematic Reviews
|November 1, 2001
Summary
Comparing tonsillectomy techniques, diathermy reduced bleeding but increased pain. More research is needed to determine the best surgical method for tonsillectomy.
Area of Science:
- Otolaryngology
- Surgical Techniques
- Evidence-Based Medicine
Background:
- Tonsillectomy is a frequent surgical procedure with multiple existing techniques.
- The comparative effectiveness of different tonsillectomy methods remains unclear.
Purpose of the Study:
- To compare the morbidity associated with tonsillectomy using dissection versus diathermy techniques.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) identified through Cochrane Controlled Trials Register, Medline, and Embase.
- Two RCTs met inclusion criteria, comparing monopolar diathermy with cold dissection and microscopic bipolar diathermy with cold dissection in pediatric and adult patients.
Main Results:
- Diathermy techniques showed reduced intraoperative bleeding compared to cold dissection.
- Increased postoperative pain was observed in the diathermy group.
- No significant difference in secondary bleeding rates was found, though studies lacked power to detect small differences.
Conclusions:
- Insufficient evidence exists to declare one tonsillectomy method superior.
- Monopolar diathermy may be associated with greater postoperative pain.
- Large, well-designed RCTs are required to establish the optimal tonsillectomy technique.