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Published on: November 6, 2019
The safety and efficacy of powered intracapsular tonsillectomy in children: A meta-analysis
Ho Seok Lee1, Ho Young Yoon1, Ho Joon Jin1
1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Insights
Powered intracapsular tonsillectomy and adenoidectomy (PITA) offers reduced postoperative pain and faster recovery compared to traditional methods. However, PITA is associated with a higher rate of tonsil regrowth, necessitating further research.
Area of Science:
- Otolaryngology
- Surgical Innovation
- Pediatric Surgery
Background:
- Tonsillectomy and adenoidectomy are common procedures in pediatric otolaryngology.
- Evaluating novel techniques like powered intracapsular tonsillectomy and adenoidectomy (PITA) is crucial for optimizing patient outcomes.
- Existing literature lacks comprehensive analysis of PITA's impact on pain, morbidity, and sleep disorders.
Purpose of the Study:
- To systematically review and meta-analyze the postoperative pain, perioperative, and postoperative morbidity associated with PITA.
- To compare PITA outcomes against extracapsular tonsillectomy in pediatric patients.
- To assess the efficacy of PITA in improving sleep-disordered breathing.
Main Methods:
- Systematic review and meta-analysis of five databases (PubMed, Scopus, Embase, Web of Science, Cochrane).
- Inclusion of studies comparing PITA with extracapsular tonsillectomy in pediatric patients.
- Outcomes assessed: operative time, bleeding, postoperative pain, recovery, tonsil regrowth, and sleep apnea metrics (AHI, symptomatic scores).
Main Results:
- PITA demonstrated no significant increase in operative time or intraoperative blood loss.
- Significantly reduced postoperative pain, analgesia requirements, and recovery time were observed with PITA.
- Higher incidence of postoperative tonsil regrowth was noted in the PITA group, while sleep apnea metrics improved similarly to the control group.
Conclusions:
- PITA is a safe procedure regarding intraoperative and postoperative morbidity.
- The increased rate of tonsil regrowth with PITA requires consideration.
- Further large-scale, well-designed trials are necessary to confirm these findings due to observed heterogeneity.
Objectives:
We performed a systemic review and meta-analysis regarding the postoperative pain, perioperative, and postoperative morbidity of powered intracapsular tonsillectomy and adenoidectomy (PITA) using a microdebrider as a method of tonsillectomy.
Data Sources:
Five databases (PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials) in their entirety through March 2017.
Review Methods:
We included studies in which there was a comparison between groups of patients who underwent PITA (PITA group) and those who had extracapsular tonsillectomy (control group). Articles assessing effects of PITA in the pediatric patient were systemically and independently reviewed by two researchers. The outcomes of interest were intraoperative morbidity (operative time and bleeding), postoperative morbidity (postoperative pain, recovery time, tonsil regrowth, and postoperative bleeding rate), and improvement of sleep breath disorder (apnea-hypopnea index [AHI] and symptomatic scores).
Results:
PITA did not significantly increase operative time or intraoperative blood loss. With PITA, there was significantly decreased postoperative pain, amount of analgesia, time to resumption of normal diet and activity, and incidence of postoperative admissions (due to dehydration or postoperative bleeding control) compared to those of the control group. In contrast, the incidence of postoperative tonsil regrowth was statistically higher in the PITA group than in the control group. The PITA improved AHI and obstructive sleep apnea 18-item questionnaire scores significantly, which were similar with the control group.
Conclusions:
With regard to intraoperative morbidity and postoperative morbidity, PITA is a safe procedure. However, there are high levels of heterogeneity with regard to several measured parameters. Therefore, further large, well-designed trials are required to substantiate our findings. Laryngoscope, 128:732-744, 2018.
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