Comparative Evaluation of Cold Dissection (Suture vs. Ligation) and Hot Dissection Tonsillectomy in Children:...

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Surgical Outcomes

Background:

• Tonsillectomy is a common pediatric ENT procedure.
• Postoperative pain and bleeding are significant concerns impacting recovery.
• Surgical technique may influence these outcomes.

Purpose of the Study:

• To compare postoperative pain, bleeding rates, and operative duration among three pediatric tonsillectomy techniques.
• Investigate cold dissection with suturing, cold dissection with ligation, and hot dissection with bipolar cautery.
• Identify the optimal technique for minimizing pediatric tonsillectomy morbidity.

Main Methods:

• Prospective, single-center study of 150 children undergoing tonsillectomy with adenoidectomy.
• Patients were randomized into three groups: cold dissection with suturing, cold dissection with ligation, or hot dissection with bipolar cautery.
• Pain assessed using Wong-Baker FACES and Parents' Postoperative Pain Measure (PPPM); bleeding and operative time were recorded.

Main Results:

• No significant difference in primary or secondary hemorrhage rates between groups (2.7% overall secondary hemorrhage).
• Cold dissection with ligation (Group 2) demonstrated significantly lower pain scores across all time points compared to other groups.
• Hot dissection (Group 3) had the shortest operative time but showed a trend towards higher secondary bleeding and intake difficulties.

Conclusions:

• Cold dissection with ligation provides the most favorable pain profile for pediatric tonsillectomy.
• Technique selection should prioritize reducing postoperative pain and morbidity.
• Ligation technique offers a consistent analgesic advantage, making it a preferred method for enhancing patient comfort.