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Can Intracapsular Tonsillectomy Be an Alternative to Classical Tonsillectomy? A Meta-analysis.
Jong Seung Kim1,2, Sam Hyun Kwon1,2, Eun Jung Lee1,2
11 Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Republic of Korea.
Summary
Intracapsular tonsillectomy and adenoidectomy (ICTA) reduces pain and bleeding after surgery for obstructive sleep apnea (OSA). While it may leave remnant tonsils, it does not increase infection risk and allows faster recovery.
Area of Science:
- Otolaryngology
- Surgical Techniques
- Sleep Medicine
Background:
- Tonsillectomy is a common otolaryngologic procedure.
- Postoperative complications are a concern.
- Intracapsular tonsillectomy and adenoidectomy (ICTA) preserves tonsillar capsule.
Purpose of the Study:
- Evaluate ICTA versus extracapsular tonsillectomy for obstructive sleep apnea (OSA).
- Compare efficacy in managing OSA.
- Assess reduction in postoperative complications.
Main Methods:
- Literature search of PubMed, EMBASE, and Cochrane Library (through December 2016).
- Meta-analysis of 15 randomized controlled studies.
- Summarized risk ratios (RR), risk differences (RDs), and standardized mean differences (SMDs) using random-effects models.
Main Results:
- ICTA showed significantly lower risk ratios for postoperative bleeding (RR=0.44, P=.01).
- ICTA resulted in significantly less postoperative pain, reduced need for analgesics, and faster return to normal diet and activity.
- Increased risk of remnant tonsils (RR=6.02, P=.0002) observed with ICTA, but no increased risk of recurrent infection.
Conclusions:
- ICTA effectively reduces postoperative pain and bleeding, facilitating quicker recovery.
- No significant difference in pain or bleeding between microdebrider and coblator for ICTA.
- ICTA is a viable option for OSA management with improved postoperative outcomes, despite a potential for remnant tonsils.