Systematic Review of Randomized Controlled Trials Comparing Intracapsular Tonsillectomy With Total Tonsillectomy in a Pediatric Population

Walton, Joanna; Ebner, Yaniv; Stewart, Michael G.; April, Max M.

doi:10.1001/archoto.2012.16

Cited by 83 publications

(94 citation statements)

References 31 publications

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“…These alternatives might be pharmacological, such as the use of steroidal 18 or nonsteroidal antiinflammatory drugs 19 in addition to acetaminophen, but also surgical, because the use of the intracapsular tonsillectomy technique has been shown to substantially reduce postoperative pain. 20 Finally, this case supports the clinical utility of determining CYP2D6 genotype or phenotype in preventing serious drug adverse effects and developing more individualized analgesic therapy based on therapeutic recommendations according to CYP2D6 genotype.…”

Section: Discussionsupporting

confidence: 55%

A Case of Respiratory Depression in a Child With Ultrarapid CYP2D6 Metabolism After Tramadol

Orliaguet¹,

Hamza²,

Couloigner

et al. 2015

Pediatrics

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We discuss a case of severe respiratory depression in a child, with ultrarapid CYP2D6 genotype and obstructive sleep apnea syndrome, after taking tramadol for pain relief related to a day-case tonsillectomy.Pain management is challenging after ambulatory tonsillectomy in children and has become more so since the publication of restrictions on the use of codeine for pain relief in children. 1 These restrictions followed reports of severe and fatal respiratory depression in children after the use of codeine for pain relief. [2][3][4][5][6]

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Section: Discussionsupporting

confidence: 55%

A Case of Respiratory Depression in a Child With Ultrarapid CYP2D6 Metabolism After Tramadol

Orliaguet¹,

Hamza²,

Couloigner

et al. 2015

Pediatrics

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“…According to Walton et al [38] in randomized trials early PTB was present in 3/699 (0.4%) tonsillotomy and 1/635 (0.16%) tonsillectomy patients, a nonsignificant difference. Delayed PTB was found in 5/699 (0.7%) tonsillotomy and 13/635 (2.0%) tonsillectomy patients, a statistically significant difference (p = 0.04).…”

Section: Surgical Technique: How Much Tonsil To Remove?mentioning

confidence: 96%

“…Recently, a meta-analysis of randomized trials [38] and a systemic review, which also included nonrandomized studies [39] , comparing tonsillotomy with traditional tonsillectomy, were published. According to Walton et al [38] in randomized trials early PTB was present in 3/699 (0.4%) tonsillotomy and 1/635 (0.16%) tonsillectomy patients, a nonsignificant difference.…”

Section: Surgical Technique: How Much Tonsil To Remove?mentioning

confidence: 99%

Hemorrhage after Tonsillectomy: Does the Surgical Technique Really Matter?

Gysin

Dulguerov

2013

ORL

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A thorough review of the publications on surgical techniques used for tonsillectomy is provided, emphasizing randomized studies and meta-analysis. In the assessment of the data it is important to clearly define and categorize the types of posttonsillectomy bleeding (PTB), as well as the various factors that have been associated with increased PTB. In recent audits of a large number of tonsillectomies, the PTB rates seem to concur: 1% early and 2.5% delayed PTB; 10% anamnestic, 2% objective, and 2% re-operation PTB. Objective PTB rates beyond 10% should require an audit. The bipolar technique seems associated with the least early PTB, while the cold technique is associated with the least delayed PTB. Because of the lack of large well-conducted randomized trials, it is difficult to conclude which technique is the best. With electrocautery techniques, the current power should be adjusted to the minimal level providing hemostasis. Surgical techniques for tonsillectomy that should probably be abandoned include monopolar electrocautery, Coblation, various lasers, and the harmonic scalpel. Vesselsealing systems might hold promise and deserve further evaluation. Tonsillotomy might be associated with less postoperative pain, but the hemorrhagic advantage in randomized studies is not obvious. Tonsil regrowth rates and efficacy to treat obstruction need also further evaluation.

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“…Of 16 randomized controlled trials (RCTs) included, the conclusion was that TT was equivalent or superior to TE concerning recovery-related outcomes. 9 However, none of the RCTs reported pre-or postoperative data from polysomnography (PSG), which is the gold standard for diagnosing OSA in children, and for grading the severity. 3 Another review concluded that "large welldesigned randomized controlled trials with an adequate follow-up are necessary to determine whether the procedure (TT) is capable of replacing TE for resolving upperairway obstruction."…”

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confidence: 99%

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

2017

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BACKGROUND: Adenotonsillectomy (ATE) is a well-established and effective treatment of pediatric obstructive sleep apnea (OSA). In recent years, a more conservative method, adenotonsillotomy (ATT), has gained popularity because it is associated with less postoperative morbidity. Yet no previous randomized study has compared these 2 methods regarding their effectiveness in treating pediatric OSA in terms of polysomnographic data, which was the primary aim of this study. The hypothesis was that ATT is noninferior to ATE after 1 year. METHODS: Seventy-nine children, aged 2 to 6 years, with OSA (Apnea-Hypopnea Index [AHI] 5–30) were randomized to ATT (n = 40) or ATE (n = 39). Polysomnography (PSG) and questionnaire OSA-18 were assessed at baseline and 1 year postsurgery. RESULTS: Mean difference between groups in the primary outcome, change in AHI, was 0.83, 95% confidence interval –3.2 to 4.9, not exceeding the noninferiority margin of 5. After ATE, AHI decreased from median 12.7 (interquartile range 8.3–19.1) to 2.0 (1.2–3.1) and after ATT from 15.8 (8.5–21.2) to 4.0 (1.2–5.1). For both groups, significant improvements of PSG and OSA-18 questionnaire outcomes were observed, with no significant differences between groups. Five children (13%) in the ATT group needed repeated surgery for tonsil regrowth and recurrence of OSA. CONCLUSIONS: The results suggest that ATT is noninferior to ATE in treating pediatric OSA regarding PSG outcomes after 1 year. ATT could be considered an alternative to ATE for treatment of pediatric OSA. However, after ATT, there is a nonnegligible risk of recurrence of OSA, and this should be taken into account when selecting surgical method.

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Systematic Review of Randomized Controlled Trials Comparing Intracapsular Tonsillectomy With Total Tonsillectomy in a Pediatric Population

Abstract: Recovery-related outcomes for IT were superior to TT (secondary hemorrhage rate, number of days until pain free) in a pediatric population with obstructive symptoms (level-1 evidence).

Cited by 83 publications

References 31 publications

A Case of Respiratory Depression in a Child With Ultrarapid CYP2D6 Metabolism After Tramadol

A Case of Respiratory Depression in a Child With Ultrarapid CYP2D6 Metabolism After Tramadol

Hemorrhage after Tonsillectomy: Does the Surgical Technique Really Matter?

Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT

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