Guillotine versus dissection tonsillectomy: randomised, controlled trial

Abstract

Link to this article: http://journals.cambridge.org/abstract_S002221511200196XHow to cite this article: S J Frampton, M J A Ward, V S Sunkaraneni, H IsmailKoch, Z A Sheppard, R J Salib and P K Jain Guillotine versus dissection tonsillectomy: randomised, controlled trial. AbstractObjective: This trial aimed to compare the guillotine technique of tonsillectomy with 'cold steel' dissection, the current 'gold standard'.Design: A single centre, randomised, controlled trial. Methods: One hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intraoperative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared.Results: Operative time and intra-operative blood loss were both significantly less for the guillotine technique ( p < 0.001) and there was a significantly reduced haemostasis requirement ( p < 0.001). Pain was also less on the guillotine side ( p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage. Conclusion:This study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

“…PTH may have been reported as primary (generally defined as occurring within 24 hours of surgery), secondary (generally defined as occurring more than 24 hours postoperatively), or at an undefined or unspecified time. 8–108 Seventy-three studies contributed data to the meta-analysis (66 RCTs, 19,20,23,25,27,29,33,34,36,38–41,43,44,46,47,49,50,52–59,62–64,67,71,72,74–79,81–84,88–92,95,101–105,108–122 6 nonrandomized trials, 24,35,37,45,48,94 and 1 prospective cohort study 70 ). The resulting subset of studies included the following tonsillectomy techniques: cold dissection, electrocautery, coblation, harmonic scalpel, laser, molecular resonance, thermal welding, and microdebrider.…”

“…8–15,19,20,23,25,27,33–41,43–47,50–59,62–64,67,70–79,81–84,88,89,91,92,94–98,101,102,106–108,177 The 6299 children across studies who were treated with total tonsillectomy experienced 265 episodes (4.2%) of PTH (Table 2). PTH ranged from parent-reported bleeding that did not require accessing clinical care to reoperation for hemostasis.…”

Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children

“…This difference might be explained at first by a different operation technique. It is known that tonsillectomy using the dissection technique is more painful than when the guillotine technique is used . Secondly, by differences in treatment regime at home (acetaminophen with codeine vs acetaminophen and diclofenac).…”

“…There are two surgical techniques to perform tonsillectomy: a dissection and a guillotine technique, with the latter being less painful and resulting in less peri‐ and postoperative hemorrhage . Recent research suggests that pain after (dissection) tonsillectomy is often inadequately treated .…”

Anesthesiological considerations for children with obstructive sleep apnea

“…It has been shown that the degree postoperative pain relates in part to the surgical approach for tonsillectomy, for example, radiofrequency versus dissection versus guillotine versus microdebrider [33][34][35][36][37][38] with extensive use of electrocautery resulting in the most postoperative pain. A recent suggestion has been to perform partial tonsillectomy to reduce airway obstruction while avoiding complete tonsillectomy and thus significantly reducing postoperative pain and therefore reducing the need for postoperative opioids [36,39].…”