Incidence and Characteristics of Revision Adenoidectomy Among Pediatric Patients at King Abdulaziz University Hospital in Saudi Arabia

Abstract

BackgroundAdenoidectomy is the most commonly performed pediatric operation worldwide and one of the most frequent otorhinolaryngological procedures. It is a safe procedure with a low risk of complications. However, after a successful adenoidectomy, few patients experience symptoms of nasal obstruction, suggestive of adenoid regrowth. Because of various risk factors, patients require a revision adenoidectomy. This study aimed to determine the incidence of revision adenoidectomy at King Abdulaziz University Hospital (KAUH). Moreover, we aimed to identify the characteristics and factors that present a risk of revision adenoidectomy in pediatric patients. Materials and MethodsWe retrospectively reviewed the medical records of 680 pediatric patients (age below 18 years) of Saudi and non-Saudi descent who underwent a prior adenoidectomy with or without tonsillectomy, as well as those who underwent a revision adenoidectomy. The data from 2015 to 2018 were obtained from the hospital medical records using a data collection sheet.The data were entered on to a Microsoft excel sheet, and descriptive statistical analysis was performed using IBM SPSS software V21 (IBM Corp., Armonk, NY). ResultsThe incidence of revision adenoidectomy at our center was 2.79%. We found significant relationships between comorbidities and revision adenoidectomy (p=0.014), initial adenoidectomy without tonsillectomy and revision adenoidectomy (p=0.001), and a young age at initial surgery and revision adenoidectomy. The mean age at initial adenoidectomy was 2.5 years (standard deviation [SD], ±0.607 years), whereas that at revision adenoidectomy was 1.89 years (SD, ±0.737 years). The mean interval between primary and revision adenoidectomies was 42.32 months (range, 9-86 months). ConclusionThe incidence of revision adenoidectomy at KAUH was 2.79%. Moreover, only adenoidectomy without a tonsillectomy presented a high risk of adenoid regrowth necessitating a revision adenoidectomy. Therefore, we recommend counseling patients to undergo an adenoidectomy with tonsillectomy to reduce the risk of revision adenoidectomy.

Prevalence of revision adenoidectomy in a tertiary otorhinolaryngology centre in Nigeria

“…In our study, we also found that children presenting with clinical features of recurrent tonsillitis carried a higher odd of having revision adenoidectomy ( P = 0.006). This is similar to findings by Alsharif et al [ 28 ] This may be due to the effects of factors such as allergy, infection, and acid reflux on the pharyngeal mucosa. [ 8 ] Studies have demonstrated a high incidence of gastric acid reflux among children undergoing adenoidectomy, and this is found to be associated with mucosal edema and inflammation in the pharynx, leading to adenoid and tonsil hyperplasia/hypertrophy, and hence a risk for recurrent tonsillitis and revision adenoidectomy.…”

“…[ 8 ] Studies have demonstrated a high incidence of gastric acid reflux among children undergoing adenoidectomy, and this is found to be associated with mucosal edema and inflammation in the pharynx, leading to adenoid and tonsil hyperplasia/hypertrophy, and hence a risk for recurrent tonsillitis and revision adenoidectomy. [ 8 28 29 ] However, as we could not ascertain the presence or absence of acid reflux in the cohort, it is thus difficult to establish a causal relationship.…”

“…Similar hospital-based studies have reported that children who underwent adenoidectomy without tonsillectomy are at a risk of having a revision adenoidectomy. [ 14 26 28 ]…”

Effective treatment of a child with adenoidal hypertrophy and severe asthma by omalizumab: a case report

“…At present, adenoidectomy is the definitive method for managing AH worldwide, but it may be associated with a variety of complications, including hemorrhage, infections, palate dysfunction and the risks associated with general anesthesia. In addition, there is still a possibility of recurrence after surgery [ 6 ]. It is estimated that 20–30% children with OSAS could have symptoms returned after surgery, about 50% of which were due to adenotonsillar regeneration.…”