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The safety and efficacy of powered intracapsular tonsillectomy in children: A meta‐analysis
Author(s) -
Lee Ho Seok,
Yoon Ho Young,
Jin Ho Joon,
Hwang Se Hwan
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26886
Subject(s) - medicine , tonsillectomy , adenoidectomy , obstructive sleep apnea , tonsil , perioperative , postoperative pain , randomized controlled trial , meta analysis , anesthesia , incidence (geometry) , surgery , hypopnea , apnea , polysomnography , physics , optics
Objectives We performed a systemic review and meta‐analysis regarding the postoperative pain, perioperative, and postoperative morbidity of powered intracapsular tonsillectomy and adenoidectomy (PITA) using a microdebrider as a method of tonsillectomy. Data Sources Five databases (PubMed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials) in their entirety through March 2017. Review Methods We included studies in which there was a comparison between groups of patients who underwent PITA (PITA group) and those who had extracapsular tonsillectomy (control group). Articles assessing effects of PITA in the pediatric patient were systemically and independently reviewed by two researchers. The outcomes of interest were intraoperative morbidity (operative time and bleeding), postoperative morbidity (postoperative pain, recovery time, tonsil regrowth, and postoperative bleeding rate), and improvement of sleep breath disorder (apnea‐hypopnea index [AHI] and symptomatic scores). Results PITA did not significantly increase operative time or intraoperative blood loss. With PITA, there was significantly decreased postoperative pain, amount of analgesia, time to resumption of normal diet and activity, and incidence of postoperative admissions (due to dehydration or postoperative bleeding control) compared to those of the control group. In contrast, the incidence of postoperative tonsil regrowth was statistically higher in the PITA group than in the control group. The PITA improved AHI and obstructive sleep apnea 18‐item questionnaire scores significantly, which were similar with the control group. Conclusions With regard to intraoperative morbidity and postoperative morbidity, PITA is a safe procedure. However, there are high levels of heterogeneity with regard to several measured parameters. Therefore, further large, well‐designed trials are required to substantiate our findings. Laryngoscope , 128:732–744, 2018