Introduction and Aims: There is no consensus on the optimal tonsillectomy technique in adult patients. The study aims to identify all studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary outcomes were hemorrhage and postoperative pain. Secondary outcome measures included return to theatre, analgesia, intraoperative bleeding, diet, tonsillar healing, and operation time. Fixed-effects modeling was used for the analysis. Results: Six studies were identified enrolling a total of 1824 patients. There were no significant differences in terms of reactionary hemorrhage (OR = 1.81, P = .51), delayed hemorrhage (OR = 0.72, P = .20), or postoperative pain (mean difference = −0.15, P = .45); however, there is a general trend favuring coblation. For secondary outcomes, no significant differences noted in terms of intraoperative bleeding, diet, and cases returning to theatre. Analgesia administration was either insignificant or higher in the coblation group. The coblation group had longer operation time and greater healing effect on tonsillar tissue. Conclusions: There were no significant differences in outcomes for coblation and bipolar diathermy for adult tonsillectomy patients in this systematic review and meta-analysis.
Introduction
There is no consensus on the most superior tonsillectomy technique in adult patients. Recent trials involving coblation technique have shown promising results.
Aim
The study aims to compare the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy.
Methods
A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a search of electronic information was conducted to identify all Randomised Controlled Trials (RCTs) as well as non-randomised studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Reactionary haemorrhage, delayed haemorrhage and postoperative pain were primary outcome measures. Secondary outcome measures included a return to theatre, administration of analgesia, intraoperative bleeding, diet, the effect on tonsils (degree of healing of tonsillar fossae) and operation time. Fixed effects modelling was used for the analysis.
Results
Four RCTs and two non-randomised studies were identified enrolling a total of 1824 patients. There were no significant differences between the coblation and bipolar groups in terms of reactionary haemorrhage (Odds Ratio [OR] = 1.81, P = 0.51), delayed haemorrhage (OR = 0.72, P = 0.20) or post-operative pain by day 7 (standardised Mean Difference [MD] = -0.15, P = 0.45). For secondary outcomes, there were no differences noted in terms of intraoperative blood loss, diet and the number of cases returned to theatre. Administration of analgesia was reported to be either insignificant between the two groups or higher in the coblation group Also, the coblation group had longer operation time and greater healing effect on tonsillar tissue.
Conclusions
Coblation is neither a superior or inferior option when compared to bipolar diathermy used in the current clinical practice for adult patients undergoing tonsillectomy as both techniques have similar haemorrhage rates and post-operative pain whilst also lengthening the operative time in coblation.
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