Comparison of Intraoperative and Postoperative Morbidity between Carbondioxide Laser Tonsillectomy and Dissection Tonsillectomy: A Randomised Clinical Trial

Abstract

Introduction: Tonsillectomy is one of the most common procedures done in Ear, Nose and Throat department. Various methods of tonsillectomy have come into practice starting from dissection and snare to the recent coblation methods. Dissection and Snaring causes endothelial injury and release of tissue thromboplastin that results in aggregation of platelets and platelet plug formation and controls bleeding. It causes open wound that results in the exposure of nerves. On the other hand, CO2 LASER produces a characteristic wound that results in very minimal thermal effects on nearby non-targeted tissues. Postoperative morbidity is determined by the degree of thermal injury to the oropharyngeal mucosa that is less with dissection method. Reduced intraoperative time reduces unnecessary hospital stay and also increases patients turnover. Aim: To compare CO2 LASER tonsillectomy and dissection tonsillectomy in terms of intraoperative time, intraoperative bleeding and postoperative pain. Materials and Methods: This was a randomised study done on 126 consenting patients; randomised into two groups. Inclusion criteria were; children and young adults of age group 7-18 years with chronic tonsillitis and fulfilling diagnostic Scottish Intercollegiate Guidelines Network (SIGN) criteria. Results: The mean operative time for CO2 LASER group was 31.2 minutes (range 20 to 45 minutes) and 53.89 minutes (range 20 to 90 minutes) for dissection group with p<0.001. The mean intraoperative bleeding for CO2 LASER group was 40.8 mL (range 20.5 to 84.9 mL) compared with 80.2 mL for dissection group (range 44.4 to 117.2 mL) with p-value <0.001. The mean pain scores Visual Analog Scale (VAS) on postoperative day 1 in CO2 LASER group was 5.52 (range 3 to 8) and 4.87 (range 2 to 8) for dissection group with p=0.007. The mean pain score on postoperative day 7 in CO2 LASER group was 2.65 (range 2 to 6) and 2.00 (range 1 to 4) for dissection group with p-value <0.001. Conclusion: To conclude, tonsillectomy with CO2 LASER method is associated with less intraoperative time, less intraoperative bleeding but with more postoperative pain. Though laser tonsillectomy is proven for its efficacy and proven benefits, we suggest that the advantages of Laser tonsillectomy over conventional techniques have to be outweighed with respect to availability of resources and patient preferences.

Keywords

• haemorrhage
• operative time
• postoperative pain