Impact of Adenotonsillectomy on Weight Gain in Children: A Systematic Review

Background: Adenotonsillectomy (AT) is a common surgical procedure among pediatrics, usually performed to treat obstructive sleep apnea (OSA), recurrent tonsillitis, and chronic adenoid hypertrophy. The aim of our systematic review is to evaluate the relationship between AT and postoperative weight gain in children to guide clinicians in optimizing surgical outcomes. Methods: A systematic search was conducted following the PRISMA guidelines in PubMed, MEDLINE, and Web of Science databases. Studies evaluating weight, BMI, and growth parameters before and after AT were included. Data were collaboratively extracted, including patient demographics, baseline weight status, comorbidities, and long-term outcomes. Results: Underweight children (less than the 3rd percentile on the growth chart) who underwent AT often experienced "catch-up growth" in weight, while obese children (above the 95th percentile on the growth chart) had postoperative weight gain that exacerbated pre-existing obesity. These outcomes were affected by factors such as baseline weight, age, and comorbid conditions. Conclusions: AT can improve the quality of life in underweight children, while overweight or obese children need careful monitoring and nutrition counseling postoperatively to mitigate excessive weight gain. More randomized trials are needed to better understand the metabolic and growth implications of AT and to refine clinical guidelines.