Intracapsular tonsillectomy versus extracapsular tonsillectomy: a safety comparison

J Laryngol Otol. 2022 Aug;136(8):720-725. doi: 10.1017/S0022215121002565. Epub 2021 Sep 29.

Abstract

Objective: Post-tonsillectomy haemorrhage remains a significant complication despite modifications of technique and instrumentation. Intracapsular tonsillectomy spares the capsule as a protective barrier for underlying blood vessels and musculature. Its efficacy in children with sleep-disordered breathing has been established, along with lowered rates of haemorrhage and pain, but research pertaining to adults and for recurrent infections has been limited.

Method: This retrospective study, encompassing 730 patients, compared post-operative haemorrhage rates between extracapsular (n = 379) and intracapsular tonsillectomy (n = 351) across all ages and indications using CoblationTM technology.

Results: A significant difference in post-operative haemorrhage rate was observed between extracapsular and intracapsular tonsillectomy techniques (2.1 vs 0.3 per cent; p = 0.025). In addition, an age of 18 years or older was also found to be an independent risk factor for post-operative haemorrhage (p = 0.01).

Conclusion: CoblationTM intracapsular tonsillectomy was shown to be safe and effective across all ages and indications, with a low risk of bleeding and revision surgery.

Keywords: Adenoids; Airway Obstruction; Palatine Tonsils; Postoperative Hemorrhage; Sleep Apnea Syndromes; Tonsillectomy; Tonsillitis.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Humans
  • Pain, Postoperative
  • Postoperative Hemorrhage / epidemiology
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / surgery
  • Reoperation
  • Retrospective Studies
  • Sleep Apnea Syndromes* / surgery
  • Tonsillectomy* / methods