Comparison of Tonsillectomy Techniques and their Histopathological Healing Patterns

Abstract

Objective: This study aims to identify the tonsillectomy method offering the lowest post-opera-tive morbidity, complications and the best healing pattern.
Study Design: Prospective, randomized, double-blinded study.
Setting: Tertiary care hospital. Subjects and Methods: One hundred and eighty adult male patients complaining of recurrent tonsillitis were enrolled in the study. All the participants were randomly assigned to one of the techniques, including cold knife tonsillectomy (CLST, n=30), electrocautery (ELCTR, n=30), Sutter radiofrequency tonsillectomy (SRF, n=30), plasmacision (PLCS, n=30), coblation (CBL, n=30) and thermal welding (THRWL, n=30). The age of the patient, operative time, bleeding control time, need for additional cautery, amount of blood loss, the degree of difficulty of the technique, post-operative pain in the 1st, 3rd and the 5th days and post-operative complications were recorded.
Results: The SRF group had the least operative time between 3 to 20 minutes (average 10.4±4.28 min. The longest operative time with THRWL ranged between 17-28 minutes (average 22.66 ±4.36 min.) (p<0.00001). CLST showed the least, while PLCS was characterised with the most pain in the 3rd post-operative day (p=0.0026). On the 5th day, the pain scores were similar to that of the 3rd day (p=0.0037). Histopathologically, necrosis was least in CBL and most in PLCS (p<0.00001). Vascular proliferation was least in SRF and most in CBL (p<0.00001). Lymphocyte and histocyte migration was least in the CBL and most in the PLCS (p<0.00001).
Conclusion: Although, inexpensive, CLST is accompanied by a significant amount of intra-operative blood loss and operative time. SRF, CBL and THRWL techniques seemed to have reasonable post-operative pain, lower amounts of blood loss and lower tissue reactions.