Guillotine versus dissection tonsillectomy: randomised, controlled trial.

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Surgical Techniques

Background:

• Tonsillectomy is a common surgical procedure in children.
• Cold steel dissection is the current standard for tonsillectomy.
• Alternative techniques aim to improve efficiency and reduce patient discomfort.

Purpose of the Study:

• To compare the guillotine technique with cold steel dissection for tonsillectomy in children.
• To evaluate operative time, blood loss, haemostasis, and post-operative pain.

Main Methods:

• A single-center, randomized controlled trial involving 100 children aged 3-11 years.
• Each patient underwent tonsillectomy with one tonsil removed by each technique (guillotine vs. cold steel).
• Blinded assessment of operative time, intra-operative blood loss, haemostasis, and pain scores.

Main Results:

• The guillotine technique showed significantly less operative time (p < 0.001) and intra-operative blood loss (p < 0.001).
• Reduced haemostasis requirement (p < 0.001) and lower post-operative pain scores were observed with the guillotine method (p < 0.001).
• No significant differences in tonsillar remnants, palatal trauma, or secondary hemorrhage frequency between the techniques.

Conclusions:

• Guillotine tonsillectomy is an effective and time-efficient procedure for children with mobile tonsils.
• It offers advantages over cold steel dissection, including reduced blood loss and post-operative pain.
• Provides Level Ib evidence supporting the use of the guillotine technique.