Pediatric tonsillectomy: post-operative morbidity comparing microsurgical bipolar dissection versus cold sharp dissection

The Use of Bipolar Electrocautery Tonsillectomy in Patients with Pediatric Respiratory Tract Obstruction

“…Some of the studies argue that postoperative pain increases with bipolar electrocautery. The tonsil bed healed later in these patients and the increase in pain was seen to be related to this [12]. Again the same patient underwent surgery receiving different surgical techniques on the right and left tonsils, and eventually it was seen that the bipolar cautery side had more pain than the conventionally operated one (15).…”

“…Today bipolar electrodissection method, which was defined in 1993, is also being widely used as well as the conventional dissection method [11]. This method has been shown to shorten operation time because it enables the simultaneous realization of dissection and coagulation [12,13,14,15,16,17,18]. Although there are studies pointing to an opposite direction [19,20] the former have been generally accepted by the medical community.…”

Complicações pós-operatórias em tonsilectomias

“…Otalgia foi significantemente mais freqüente nos pacientes submetidos a A2 no primeiro pós-operatório, sem diferenças em 1 semana e 1 mês. Em geral os estudos comparam técnicas cirúrgicas a quente (eletrocautério) e a frio (técnicas de dissecção), sendo que a primeira reduz o tempo cirúrgico e o sangramento intra-operatório 14 , porém em geral os pacientes apresentam significantemente mais dor no pós-operatório 15,16 , não sendo procedimento recomendado de rotina 15,16 . Homer et al 17 observaram que a técnica de Sluder provoca menos dor no pós-operatório, resultado este não constatado no presente estudo.…”

Obstructive sleep apnea and tonsillectomy: do we have a new indication for extended postoperative observation?

“…There may be other factors that have not been examined such as the fact that senior surgeons tend to get the morning schedule and more junior surgeons get the afternoon time; perhaps surgical technique is another issue. [20][21][22][23] Additional covariates such as body positions during sleep, obesity, gender, and ethnic origin may also be important; these covariates were not all quantitated in the Koomson study. [24][25][26][27] Regardless of the flaws in the Koomson study, they have turned over a rock and now new interesting questions have been raised.…”

“…Il existe peut-être d'autres facteurs, non examinés, comme le fait que les chirurgiens seniors aient tendance à travailler le matin et que les chirurgiens plus jeunes se retrouvent en salle d'opération l'après-midi ; aussi, il faut peut-être considérer la technique chirurgicale comme une autre variable. [20][21][22][23] Des covariables supplémentaires, comme la position du corps pendant le sommeil, l'obésité, le sexe et l'origine ethnique pourraient aussi être importantes, mais elles ne sont pas quantifiées dans l'étude de Koomson. [24][25][26][27] Mis à part les défauts de l'étude, les auteurs ont mis au jour de nouveaux faits et soulevé de nouvelles questions fort intéressantes.…”