Coblation versus dissection tonsillectomy in children

IntroductionThe palatine tonsil consists of paired of lymphoid tissue found in the lateral walls of the oropharynx within a tonsillar fossa which formed by three pharyngeal muscles primarily the superior constrictor. 1 Tonsillectomy is one of the most common surgical procedures performed in Otolaryngology.Several different techniques for performing tonsillectomy have been described as attempts to lower the inherent morbidity of this surgery.2,3 Described techniques include blunt dissection, gullitone excision, cryosurgery, monopolar and bipolar diathermy dissection, bipolar scissors dissection, ultrasonic scalpel, tonsillectomy, laser dissection and recently introduced coblation-assisted tonsillectomy.There is still controversy over which is the optimal technique of tonsillectomy with the lowest morbidity rates.4,5 Dissection tonsillectomy remains the most commonly performed tonsillectomy technique.In this procedure tonsillectomy performed by grasping the tonsil by tonsil holder forceps and pulling it medially then doing an incision in the mucous membrane where it reflects from the tonsil to anterior pillar.After complete dissection, the surgeon will clamp the lower pole and ligate it.Bleeding is mainly venous and hemostasis may be achieved Background and objective: Tonsillectomy is the surgical procedure of removing the tonsils.Various methods of tonsillectomy have been practiced aimed at decreasing or eliminating intraoperative and postoperative morbidity.This study was conducted to determine the different outcomes of tonsillectomy surgery in both coblation and dissection techniques.Methods: A prospective control study was conducted with a total sample size of 66 patients.Each patient underwent tonsillectomy by using ArthroCare Coblator on the right side and dissection method on the left side.Children between the age of 3-12 years old were selected with indications of recurrent tonsillitis and/or kissing tonsil causing snoring and/or sleep apnea.Children with peritonsillar abscess, malignancy, bleeding disorder were excluded.Operative time and blood loss, postoperative pain, bleeding and healing process were compared between two methods.Operations performed by the same surgeon.Results: The intraoperative time was significantly shorter (P <0.001) and intraoperative blood loss was significantly lesser (P <00.01) in coblation as compared to dissection tonsillectomy, while there were no significant differences in the postoperative pain scores on 1 st , 2 nd , 7 th and 14 th postoperative days.There was a significant healing process in tonsillar fossa in favor of coblation rather than dissection.No primary or secondary postoperative bleeding was reported.Conclusion: Coblation tonsillectomy is a safe procedure with significantly less intraoperative time and less blood loss and better surgical wound healing with similar postoperative pain in comparison with dissection tonsillectomy.