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Intervention Review

Dissection versus diathermy for tonsillectomy

  1. Darren K Pinder1,
  2. Malcolm P Hilton2

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 31 MAY 2003

DOI: 10.1002/14651858.CD002211

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Author Information

  1. 1

    John Radcliffe Hospital - West Wing, Department of Otolaryngology, Oxford, UK

  2. 2

    Royal Devon & Exeter Hospital, ENT Department, Exeter, Devon, UK

Publication History

  1. Published Online: 21 JAN 2009

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Abstract

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  2. Abstract
  3. Plain language summary

Background

Tonsillectomy is a commonly performed surgical procedure. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated.

Objectives

To compare the morbidity associated with tonsillectomy by two different techniques - dissection and diathermy.

Search strategy

The Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966-2003), EMBASE (1974-2003). The date of the last search was June 2003. Reference lists were scanned for additional material.

Selection criteria

Randomised controlled trials of children and adults undergoing tonsillectomy or adenotonsillectomy by dissection or diathermy techniques. Trials were assessed for methodological quality according to the method outlined in the Cochrane Reviewers Handbook.

Data collection and analysis

The reviewers assessed each trial and extracted data independently.

Main results

Twenty-two potential studies were identified for further assessment. Twenty trials were not included because they did not meet the inclusion criteria for randomisation methods, controls or outcome criteria. Two trials met the inclusion criteria, one comparing monopolar dissection diathermy with conventional cold dissection in children, and the other comparing microscopic bipolar dissection with cold dissection in children and adults. These studies demonstrate reduced intraoperative bleeding, but increased pain in the diathermy group. There was no difference in the rate of secondary bleeding overall, although the power of both studies to detect a small difference was insufficient.

Authors' conclusions

There are insufficient data to show that one method of tonsillectomy is superior. There is evidence that pain may be greater after monopolar dissection. Large, well designed randomised controlled trials are necessary to determine the optimum method for tonsillectomy.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Not enough evidence to show the best way to remove tonsils surgically

Tonsillectomy is one of the most common operations. Complications can include bleeding, during or after the operation, and pain. This review compared the effectiveness of two different surgical techniques in reducing these complications. The surgical techniques were diathermy (the use of high-frequency electrical current to cut tissue, remove the tonsil and control blood loss), and traditional cold dissection (where the tonsil is cut away and blood loss then controlled with ties, stitches or diathermy). The review of trials found that there is not enough evidence to demonstrate that diathermy is more effective than dissection. There was some evidence that patients who had diathermy tonsillectomy had less bleeding during the operation but more pain afterwards, however more research is needed.

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