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Published on: November 6, 2019
Coblation intracapsular tonsillectomy in children: A prospective study of 1257 consecutive cases with long-term
Nikul Amin1, Eishaan Bhargava1, James George Prentice1
1Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Insights
Coblation intracapsular tonsillectomy (ICT) in children shows reduced pain and faster recovery. While generally safe, revision surgery is needed in 2.6% of cases, particularly for younger children or those with severe obstructive sleep apnea or comorbidities.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Quality of Life Research
Background:
- Intracapsular tonsillectomy (ICT) is gaining popularity in pediatric centers due to benefits like reduced pain and quicker recovery.
- However, its effectiveness for recurrent tonsillitis and the risk of tonsillar regrowth requiring revision surgery remain areas of ongoing investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of Coblation intracapsular tonsillectomy (ICT) in pediatric patients.
- To assess health-related quality of life (HRQL), pain management, complication rates, and parental satisfaction.
- To determine the rate of revision surgeries and identify associated predictive factors.
Main Methods:
- A prospective consecutive case series was conducted from March 2013 to April 2020 at a tertiary pediatric ENT referral center.
- 1257 pediatric patients underwent Coblation ICT, with or without adenoidectomy, for obstructive and/or infective indications.
- Outcomes measured included HRQL, analgesia needs, hemorrhage rates, recovery time, parental satisfaction, and revision surgery rates.
Main Results:
- Coblation ICT significantly improved HRQL scores across all domains in pediatric patients.
- The median analgesia requirement was 6 days, with no post-operative hemorrhages requiring return to surgery.
- Revision surgery was necessary in 2.6% of cases, primarily due to tonsillar regrowth; younger age, severe obstructive sleep apnea (OSA), and severe comorbidities were identified as risk factors.
Conclusions:
- Long-term data confirm Coblation ICT is an effective and safe procedure for pediatric patients with various tonsil-related indications.
- The study highlights the benefits of ICT while also identifying specific patient groups at higher risk for revision surgery.
Objectives:
Intracapsular tonsillectomy (ICT) is increasingly adopted by paediatric centres worldwide due to its association with reduced pain, fast recovery and low risks of post-operative complications. Questions still surround its role in patients with recurrent tonsillitis, as well as tonsillar regrowth requiring revision surgery.
Design:
Prospective consecutive case series from March 2013 to April 2020.
Setting:
Tertiary paediatric ENT referral centre.
Participants:
Paediatric patients undergoing Coblation ICT, with or without adenoidectomy, for obstructive and/or infective indications.
Main Outcome Measures:
Health-Related Quality of Life (HRQL), analgesia requirement, post-operative haemorrhage rates, time to return to normal diet and activity or school/nursery, and parental satisfaction. We report revision surgery rates and identify predictive factors for revision surgery.
Results:
A total of 1257 patients (median age 4.2 years) underwent Coblation ICT, with a median direct and implied follow-up of 101.5 and 1419 days, respectively. We noted significantly improved HRQL scores across all domains. Median analgesia requirement was six days, and no patients required a return to theatre for post-operative haemorrhage. The majority of patients were eating a normal diet within 24 hours and returned to normal activity/school within a week post-operatively. Revision surgery was required in 2.6% of cases, mainly due to recurrent obstructive symptoms from tonsillar regrowth. Being under two years old at initial surgery (OR 5.10), having severe OSA (OR 4.43) or severe comorbidities (OR 2.98) increased the risk of needing revision surgery.
Conclusions:
Long-term data demonstrate the efficacy and safety of Coblation ICT in paediatric patients across a range of indications.
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