Systematic Review of Randomized Controlled Trials Comparing Intracapsular Tonsillectomy With Total Tonsillectomy in a Pediatric Population (original) (raw)
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International Journal of Pediatric Otorhinolaryngology, 2005
Objective: To determine the efficacy of powered intracapsular tonsillectomy (PIT, e.g. regrowth rate) in children who underwent PIT at three different institutions. We also wanted to determine if the trend to greater safety through reduced bleeding and re-admission for dehydration, noted in our initial reports, would become statistically significant in a larger sample. Study design and setting: Multi-center retrospective case series. Patients and methods: We retrospectively reviewed all charts' of children who underwent PIT at three different institutions: the Children's Hospital at the Cleveland Clinic, Alfred I.
Can Intracapsular Tonsillectomy Be an Alternative to Classical Tonsillectomy? A Meta-analysis
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2017
Objective Tonsillectomy is the most common operation performed in the otolaryngologic fields. Efforts have been made to reduce postoperative complications, and one of these is intracapsular tonsillectomy and adenoidectomy (ICTA), which leaves the tonsillar tissue with tonsillar capsule. This study aimed to evaluate intracapsular tonsillectomy compared with classical extracapsular tonsillectomy in terms of efficacy of the technique for managing obstructive sleep apnea (OSA) and reducing postoperative complications. Data Sources We performed a literature search using PubMed, EMBASE, and the Cochrane Library through December 2016. Review Methods Summarized risk ratio (RR), risk differences (RDs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated by summarizing the risk estimates of each study using random-effects models that considered both within- and between-study variations. Results Our search included 15 randomized controlled studies. The R...
International journal of pediatric otorhinolaryngology, 2005
To compare the long-term effects (six years after surgery) of two techniques for pediatric tonsil surgery with respect to snoring, apneas, eating difficulties, infections and general health. The two methods were intracapsular partial tonsillectomy (tonsillotomy, "TT") using CO(2)-laser technique and traditional (total) blunt dissection tonsillectomy (TE). A questionnaire distributed by mail to the parents of children, who, in 1998, were included in a prospective clinical randomized study in one tertiary care ENT clinic. A 10 question survey follow-up of 41 children, between 9 and 15 years of age, who originally, six years earlier had been randomized to either TT with CO(2)-laser (n=21) or TE (n=20). The main indication for the surgery was a history of sleep related breathing distress (SRBD). Before the present study, all of the children had participated in earlier follow-ups at six months and one year after surgery. All the children in both groups answered the questionnair...
Pediatric tonsillectomy: clinical practice guidelines
European annals of otorhinolaryngology, head and neck diseases, 2012
This article presents the Clinical Practice Guidelines for Pediatric Tonsillectomy of the French Society of ENT and Head and Neck Surgery (SFORL), entitled "Amygdalectomie de l'enfant : Recommandation pour la pratique clinique" (SFORL, 2009). The French Society of ENT (SFORL), in partnership with the French Association for Ambulatory Surgery (AFCA) and French Society for Anaesthesia and Intensive Care (SFAR), set up a representative panel in the fields of anesthesiology, ENT and head-and-neck surgery, pediatrics, sleep medicine and general medicine. Following the literature analysis reported in the Presentation of the Guidelines, recommendations were drawn up taking account of risk/benefit ratios, levels of evidence, feasibility in pediatric tonsillectomy and baseline risk assessment in the relevant population. Around 50,000 pediatric tonsillectomies, with or without associated adenoidectomy, are performed in France each year. Postoperative morbidity and mortality are ...
Intracapsular Partial Tonsillectomy for Tonsillar Hypertrophy in Children
The Laryngoscope, 2002
Objective: To review our experience with intracapsular tonsillectomy using powered instrumentation in the management of tonsillar hypertrophy causing obstructive sleep-disordered breathing in children. Study Design: Retrospective case series. Methods: Intracapsular tonsillectomy, a form of partial tonsillectomy performed with an endoscopic microdebrider, preserves the tonsillar capsule as a barrier to exposure of the pharyngeal muscles. Results in 150 children who underwent this procedure were compared with those in 162 children who had standard tonsillectomy. Results: Children who underwent intracapsular tonsillectomy had significantly less pain throughout the recovery period than those who had standard tonsillectomy. There was no significant difference between the two groups in intraoperative blood loss, and no episodes of immediate postoperative bleeding occurred in either group. Six patients who had the standard operation and one patient who had the intracapsular procedure had delayed hemorrhage requiring hospital readmission. Five children in the standard group and one in the intracapsular group were readmitted because of dehydration. Thus, in all, 11 readmissions were necessary among children who underwent standard tonsillectomy, whereas 2 were required among those who had intracapsular tonsillectomy. Conclusion: Intracapsular tonsillectomy is as effective as standard tonsillectomy in relieving obstructive sleep-disordered breathing but produces less postoperative pain and fewer episodes of delayed hemorrhage and dehydration.
Clinical Practice Guideline: Tonsillectomy in Children (Update)
Otolaryngology-Head and Neck Surgery, 2019
Objective. This update of a 2011 guideline developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children \15 years of age based on the most recent published data. This guideline is intended for all clinicians in any setting who interact with children who may be candidates for tonsillectomy. KAS 14 (Postoperative codeine), and KAS 15a (Outcome assessment for bleeding). (6) Addition of an algorithm outlining KASs. (7) Enhanced emphasis on patient and/or caregiver education and shared decision making.
Powered intracapsular tonsillectomy: for pediatric tonsillar hypertrophy
International Congress Series, 2003
Objective: To introduce a new technique, ''intracapsular'' tonsillectomy for the management of tonsillar hypertrophy causing obstructive sleep disordered breathing in children. Design: Retrospective case series, comparing 150 children who had intracapsular tonsillectomy (Group 1) with 162 children who had standard tonsillectomies (Group 2). Method: Intracapsular tonsillectomy is a form of ''partial'' tonsillectomy performed with an endoscopic microdebrider. It is based on the principle of preserving the tonsillar capsule as a barrier to exposure of the pharyngeal musculature, preventing their injury and inflammation. Results: Children with intracapsular tonsillectomy (Group 1) had significantly less post-operative pain throughout their recovery compared with the children who had standard tonsillectomy (Group 2). There was one episode of delayed hemorrhage in Groups 1 and 6 episodes of delayed hemorrhage in Group 2. Conclusion: Intracapsular tonsillectomy is equally effective in relieving obstructive sleep disordered breathing as standard tonsillectomy, but results in less post-operative pain and less delayed hemorrhage. D 2003 Published by Elsevier B.V.
Clinical Practice Guideline: Tonsillectomy in Children
Otolaryngology -- Head and Neck Surgery, 2011
Objective. Tonsillectomy is one of the most common surgical procedures in the United States, with more than 530 000 procedures performed annually in children younger than 15 years. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil including its capsule by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Depending on the context in which it is used, it may indicate tonsillectomy with adenoidectomy, especially in relation to sleep-disordered breathing. This guideline provides evidencebased recommendations on the preoperative, intraoperative, and postoperative care and management of children 1 to 18 years old under consideration for tonsillectomy. In addition, this guideline is intended for all clinicians in any setting who interact with children 1 to 18 years of age who may be candidates for tonsillectomy.
Trials
Background Tonsillectomy is one of the most frequently performed surgeries in children and young adults worldwide. For decades, tonsillectomy was the surgical treatment of choice for recurrent acute tonsillitis. Tonsillotomy was used in some countries as an alternative to tonsillectomy only for the treatment of obstructive sleep apnea in young children. In recent years, an increase of tonsillotomy also to treat recurrent acute tonsillitis can be observed. Therefore, the German Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (G-BA) to investigate whether tonsillotomy offers advantages compared to tonsillectomy. The meta-analysis of the IQWiG including studies until 2016 revealed that the long-term benefits and harms of tonsillotomy compared to tonsillectomy are unclear. Consequently, the G-BA performed a European call for a clinical trial. A consortium of the German Professional Association of ENT-surgeons (BVHNO), the Germa...
Comparison of three tonsillectomy techniques in children
European Archives of Oto-rhino-laryngology, 2020
Purpose Tonsillectomy is still one of the most common surgical procedures worldwide performed by otorhinolaryngologists. This single-blind randomized study aimed to compare cold dissection tonsillectomy, coblation tonsillectomy, and harmonic scalpel tonsillectomy in pediatric patients in respect of intraoperative blood loss, operating time, and postoperative pain and bleeding. Methods This single-blind randomized clinical trial evaluated 82 pediatric patients aged 3-16 years (mean age: 7.23 ± 3.26 years) applied with tonsillectomy between April 2017 and March 2020. Harmonic scalpel tonsillectomy was applied to 33 (40.2%) patients, the cold knife technique to 25 (30.5%), and coblation tonsillectomy to 24 (29.3%). Results There was no statistically significant difference between the three techniques in respect of postoperative pain levels and post-tonsillectomy bleeding rates. The intraoperative bleeding rate and mean operating time were determined to be significantly lower in the harmonic scalpel group (p < 0.05). Conclusion Harmonic scalpel tonsillectomy is associated with a shorter operating time and lower intraoperative bleeding rates and similar postoperative pain score and postoperative bleeding rates compared with coblation tonsillectomy and cold dissection tonsillectomy. Harmonic scalpel tonsillectomy is a fast, safe, and effective method for tonsillectomy in children.