[Coblation tonsillectomy. Results of a pilot study]

Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials

After the surgical procedure of tonsillectomy, hemorrhage ranks among its serious postoperative complications. In this systematic review, we analyze hemorrhage following tonsillectomies performed using the coblation technique. 24 prospective, randomized, and controlled studies were included in the meta-analysis. Data of 796 patients who had undergone coblation tonsillectomy were analyzed. Hemorrhages occurred in 33 patients: 2 classified as primary and 26 as secondary hemorrhages. 5 could not be classified into either group. Overall, the total hemorrhage rate for the coblation procedure was 4.1% with a 95% confidence interval from 2.8 to 5.5%. The overall hemorrhage rate of 4.1% found in this meta-analysis shows that coblation is a safe and effective technique for tonsillectomies with a secondary bleeding rate similar to what is reported for comparable techniques such as bipolar diathermia.

[Hemorrhage rates following coblation tonsillectomy. A meta-analysis of published trials]

BACKGROUND

With over 100,000 cases annually, tonsillectomy is one of the most frequently performed ENT surgical procedures in Germany. Hemorrhage ranks among its serious postoperative complications. In this systematic review, we analyze hemorrhage following tonsillectomies performed using coblation technique.

METHODS

Of the 135 studies identified, 38 could be included in the analysis, most being prospective randomized controlled studies. Data from 6290 patients were gathered.

RESULTS

Of all tonsillectomies performed, hemorrhages occurred in 355 patients. Of these, 256 cases could be classified as 41 primary and 215 secondary hemorrhages. Overall, the total hemorrhage rate for the coblation procedure was 4.9% (95%-CI: 0.044-0.054) for the fixed effects model.

CONCLUSION

Significantly higher rates of postoperative hemorrhage were found in a few studies, yet they were well above the 95% confidence interval of 4.4-5.4% of the literature. These studies could possibly be interpreted in terms of an autodidactic learning process. As with any surgical technique, proper training is essential.

Studien zur Coblation-Tonsillektomie

BACKGROUND

Controversy surrounds the question of which technique should be preferred for tonsillectomy in order to reduce postoperative morbidity in terms of pain, bleeding, activity and return to normal diet. This study reviews the current literature on coblation tonsillectomy (CTE).

MATERIALS AND METHODS

All studies published in peer-reviewed journals reporting postoperative morbidity following CTE until July 2006 were included in our study.

RESULTS

A total of 21 studies matched our search criteria but there were excluded from further analysis because coblation was used only for volume reduction of the tonsils. Reduced morbidity was registered in eight studies, two could not identify any difference and five studies reported an increased postoperative morbidity. Seven different surgical procedures were compared in 17 studies to CTE. The patients were not followed-up in four studies and the follow-up exceeded 1 week in nine studies only. Wound inspection was performed in four studies and a better wound healing reported in two of these, but by the same authors. Postoperative bleeding requiring surgical treatment under general anaesthesia occurred with an incidence of 0% to 11.5%. Secondary bleeding (>24 h) prevailed in all but two studies. Postoperative pain was evaluated in ten studies with conflicting results.

CONCLUSIONS

The design of the current studies varies in size, age distribution, indications for surgery, the surgical techniques compared and follow-up. The results are heterogenous and further evidence is still required to show that CTE is a safe alternative. Therefore, calculation of cost-effectiveness of a commonly performed expensive CTE as a new standard technique is currently impossible.

Wundheilungsstörung nach Tonsillektomie

Tonsillectomy is one of the most commonly performed surgical procedures in the field of otorhinolaryngology. The first tonsillectomy was done about 600 B.C. [3]. This operation is indicated for patients with recurrent tonsillitis, peritonsillar abscess, hypertrophy or asymmetry of the tonsils. Even though a routine procedure, it has a relatively high risk of complications such as post operative hemorrhage, infection or impaired wound healing. The reported case involves a 20 year old female patient who developed velopharyngeal insufficiency as a result of impaired wound healing after tonsillectomy. The patient was treated conservatively and is free of discomfort after 2 months.