Randomized study comparing inflammatory response after tonsillectomy versus tonsillotomy

• Published in: European archives of oto-rhino-laryngology 2016-11, Vol.273 (11), p.3993-4001
• Main Authors: Kordeluk, Sofia, Goldbart, Aviv, Novack, Lena, Kaplan, Daniel Michael, El-Saied, Sabri, Alwalidi, Musa, Shapira-Parra, Angelica, Segal, Nili, Slovik, Yuval, Max, Puterman, Joshua, Ben-Zion
• Format: Article
• Language: English
• Subjects: Adenoidectomy - instrumentation; Adenoidectomy - methods; Adenoids; Adolescent; Biomarkers - blood; C-Reactive Protein - analysis; Child; Child, Preschool; Debridement - instrumentation; Double-Blind Method; Electrocoagulation - methods; Female; Head and Neck Surgery; Humans; Interleukin-6 - blood; Laser Therapy - methods; Leukocyte Count; Male; Medicine; Medicine & Public Health; Miscellaneous; Neurosurgery; Neutrophils; Otorhinolaryngology; Pain, Postoperative; Palatine Tonsil - pathology; Palatine Tonsil - surgery; Parents; Postoperative Hemorrhage - surgery; Prospective Studies; Sleep Apnea, Obstructive - surgery; Snoring - surgery; Surveys and Questionnaires; Tonsillectomy - instrumentation; Tonsillectomy - methods; Tumor Necrosis Factor-alpha - blood
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-016-4083-5

To determine if there was a difference in the inflammatory reaction after tonsil surgery with “traditional” techniques (tonsillectomy and adenoidectomy or TA) compared to partial intracapsular tonsillectomy and adenoidectomy (PITA). Design: Randomized, double-blind study. Setting: tertiary care academic hospital. Children under the age of 16 years with a diagnosis of obstructive sleep disordered breathing were randomly allocated into three study groups: TA with electrocautery ( n  = 34), PITA with CO 2 laser ( n  = 30) and PITA with debrider ( n  = 28). All of the children underwent adenoidectomy with a current at the same surgical procedure. Main outcome measure: c-reactive protein level (CRP) was the primary endpoint. In addition, the following were assessed: white blood cells (WBC), neutrophils (NEU), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Pre- and post-procedure measurements were compared between the groups. Parents filled out a questionnaire daily during the first postoperative week assessing pain, swallowing and snoring. CRP levels ascended higher in the PITA groups after surgery ( p  = 0.023), WBC and NEU showed the same pattern, IL-6 levels were higher in PITA group and there was no difference in TNF-alpha levels between the two types of procedures. Postoperative pain and postoperative hemorrhage were significantly lower in the PITA groups as compared to the TA group ( p  = 0.01 and 0.048). PITA in comparison to TA is associated with lower morbidity; however, the inflammatory response does not differ significantly in the first 24 h after surgery. Additional long-term studies assessing efficacy of PITA are warranted. Level of evidence: Level 1, prospective randomized controlled trial.