Scolaris Content Display Scolaris Content Display

Disección versus diatermia para la amigdalectomía

Contraer todo Desplegar todo

Referencias

References to studies included in this review

Ir a:

Kujawski 1997 {published data only}

Kujawski O, Dulguerov P, Gysin C, Lehmann W. Microscopic tonsillectomy: a double‐blind randomized trial. Otolaryngology ‐ Head and Neck Surgery 1997;117(6):641‐7.

Nunez 2000 {published data only}

Nunez DA, Provan J, Crawford M. Electrocautery (hot) vs cold dissection and snare tonsillectomy ‐ a randomized trial. Archives of Otolaryngology ‐ Head and Neck Surgery 2000;126(7):837‐41.

References to studies excluded from this review

Ir a:

Brodsky 1996 {published data only}

Brodsky L, Pizzuto M, Gendler J, Duffy L. Microbipolar dissection vs. cold knife/suction cautery tonsillectomy in children: preliminary results of a prospective study. Acta Oto‐Laryngologica. Supplement 1996;523:256‐8.

Choy 1992 {published data only}

Choy AT, Su AP. Bipolar diathermy or ligation for haemostasis in tonsillectomy? A prospective study on post‐operative pain. Journal of Laryngology and Otology 1992;106(1):21‐2.

Flint 1980 {published data only}

Flint EF. The use of the bipolar microcoagulator for haemostasis in tonsillectomy. Clinical Otolaryngology 1980;5(4):273‐5.

Haddow 2006 {published data only}

Haddow K, Montague ML, Hussain SS. Post‐tonsillectomy haemorrhage: a prospective, randomized, controlled clinical trial of cold dissection versus bipolar diathermy dissection. Journal of Laryngology and Otology 2006;120(6):450‐4.

Haraldsson 2007 {published data only}

Haraldsson P, Attner P, Fredelius L. Intrapersonal randomized controlled trial comparing bipolar scissors and conventional cold tonsillectomy. Ambulatory Surgery 13;4:14.

Kousha 2007 {published data only}

Kousha A, Fotoohi N, Banan R. Cold dissection versus bipolar electrocautery tonsillectomy. Journal of Research in Medical Sciences 2007;12(3):117‐20.

Lassaletta 1997 {published data only}

Lassaletta L, Martin G, Villafruela MA, Bolanos C, Alvarez Vicent JJ. Pediatric tonsillectomy: post‐operative morbidity comparing microsurgical bipolar dissection versus cold sharp dissection. International Journal of Pediatric Otorhinolaryngology 1997;41(3):307‐17.

Leach 1993 {published data only}

Leach J, Manning S, Schaefer S. Comparison of two methods of tonsillectomy. Laryngoscope 1993;103:619‐22.

Linden 1990 {published data only}

Linden BE, Gross CW, Long TE, Lazar RH. Morbidity in pediatric tonsillectomy. Laryngoscope 1990;100(2 Pt 1):120‐4.

MacGregor 1994 {published data only}

MacGregor FB, Albert DA, Bhattacharya AK. Post operative morbidity following paediatric tonsillectomy: a comparison of bipolar diathermy dissection and blunt dissection. International Journal of Pediatric Otorhinolaryngology 1994;31:1‐6.

Mann 1984 {published data only}

Mann DG, St George C, Scheiner E, Granoff D, Imber P, Mlynarczyk FA. Tonsillectomy ‐ some like it hot. Laryngoscope 1984;94(5I):677‐9.

Pang 1995 {published data only}

Pang YT. Paediatric tonsillectomy: bipolar electrodissection and dissection/snare compared. Journal of Laryngology and Otology 1995;109:733‐6.

Papangelou 1972 {published data only}

Papangelou L. Haemostasis in tonsillectomy. A comparison of electrocoagulation and ligation. Archives of Otolaryngology 1972;96:358‐60.

Phillipps 1989 {published data only}

Phillipps J, Thornton R. Tonsillectomy haemostasis: diathermy or ligation. Clinical Otolaryngology 1989;14:419‐24.

Pizzuto 2000 {published data only}

Pizzuto MP, Brodsky L, Duffy L, Gendler J, Nauenberg E. A comparison of microbipolar cautery dissection to hot knife cautery tonsillectomy. International Journal of Paediatric Otorhinolaryngology 2000;52:239‐46.

Roy 1976 {published data only}

Roy A, De la Rosa C, Vecchio YA. Bleeding following tonsillectomy. A study of electrocoagulation and ligation techniques. Archives of Otolaryngology 1976;102:9‐10.

Salam 1992 {published data only}

Salam MA, Cable HR. Post‐tonsillectomy pain with diathermy and ligation techniques. A prospective randomized study in children and adults. Clinical Otolaryngology 1992;17(6):517‐9.

Sengupta 1984 {published data only}

Sengupta DK, Zakzouk SM, El Sayed YAH. Ligation versus electrocoagulation ‐ a comparative study of haemostatic methods used in tonsillectomy. Saudi Medical Journal 1984;5(2):177‐82.

Tay 1995 {published data only}

Tay HL. Post‐operative morbidity in electrodissection tonsillectomy. Journal of Laryngology and Otology 1995;109(3):209‐11.

Tay 1996 {published data only}

Tay HL. Post‐tonsillectomy pain with selective diathermy haemostasis. Journal of Laryngology and Otology 1996;110:446‐8.

Watson 1993 {published data only}

Watson MG, Dawes PJ, Samuel PR, Marshall HF, Rayappa C, Hill J, et al. A study of haemostasis following tonsillectomy comparing ligatures with diathermy. Journal of Laryngology and Otology 1993;107(8):711‐5.

Weimert 1990 {published data only}

Weimert TA, Babyak JW, Richter HJ. Electrodissection tonsillectomy. Archives of Otolaryngology ‐ Head and Neck Surgery 1990;116(2):186‐8.

Wexler 1996 {published data only}

Wexler DB. Recovery after tonsillectomy: electrodissection vs sharp dissection techniques. Otolaryngology ‐ Head and Neck Surgery 1996;114:576‐81.

References to studies awaiting assessment

Ir a:

Bercin 2008 {published data only (unpublished sought but not used)}

Bercin S, Kutluhan A, Yurttas V, Bozdemir K, Yalciner G. Comparison between bipolar cautery dissection and classic dissection techniques in tonsillectomy. Kulak Burun Boğaz Ihtisas Dergis 2008;18:24‐30.

Andrea 1993

Andrea M. Microsurgical bipolar cautery tonsillectomy. Laryngoscope 1993;103:1177‐8.

Carmody 1982

Carmody D, Vamadevan T, Cooper S. Post tonsillectomy haemorrhage. Journal of Laryngology and Otology 1982;96:635‐8.

Drake‐Lee 1998

Drake‐Lee A, Stokes M. A prospective study of the length of stay of 150 children following tonsillectomy and/or adenoidectomy. Clinical Otolaryngology 1998;23:491‐5.

Haase 1962

Haase F, Noguera J. Haemostasis in tonsillectomy by electrocautery. Archives of Otolaryngology 1962;75:125‐6.

Handbook 2008

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.

RevMan 2008 [Computer program]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.

Schulz 1995

Schulz F, Chalmers I, Hayes R, Altman D. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408‐12.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Kujawski 1997

Methods

Randomisation by sealed envelope

Participants

80 children aged < 7 and 120 children aged > 7

Interventions

Microscopic bipolar dissection and haemostasis versus blunt dissection and bipolar haemostasis

Outcomes

1. Intraoperative blood loss
2. Primary and secondary haemorrhage
3. Postoperative pain scores
4. Otalgia

Notes

—

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

Allocation concealment?

Low risk

Blinding?
All outcomes

Low risk

Outcome assessors blinded except for duration of surgery and operative bleeding, evaluated by anaesthetist

Incomplete outcome data addressed?
All outcomes

High risk

41 patients (20.5%) were excluded from pain analysis in this study due to loss to follow up or antibiotic use. It is not clear to which groups these patients were allocated. We excluded pain data from this study from the review.

Free of selective reporting?

Low risk

Free of other bias?

High risk

Intraoperative blood loss estimated from blood aspirated alone, but bias felt to be minimal therefore data incorporated in review. Pain control was assessed by pain scores only. Some patients also had tympanostomy tube insertion and otalgia was measured. We excluded postoperative pain data from this study from the review.

Nunez 2000

Methods

Randomisation by sealed envelope

Participants

54 children (age 3 to 12 years)

Interventions

Monopolar dissection/haemostasis versus dissection/snare with monopolar haemostasis

Outcomes

1. Intraoperative blood loss
2. In‐patient record of number/types of analgesia
3. Patient diary record
4. Visits to GP

Notes

Monopolar dissection at 70 W with haemostasis at 30 W. Dissection tonsillectomy with Gwynne‐Evans and snare, monopolar haemostasis at 30 W.

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

Allocation concealment?

Low risk

Blinding?
All outcomes

Low risk

Outcome assessors blinded with the exception of measurement of intraoperative haemorrhage

Incomplete outcome data addressed?
All outcomes

Low risk

Children who withdrew from the trial (2) or violated the protocol (2) were not included for analysis (4 of 54 children were excluded). The protocol violations were both in the cold dissection group and were excluded because of concurrent antibiotic use or another breach of the study protocol.

Free of selective reporting?

Low risk

Free of other bias?

Low risk

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Brodsky 1996

Outcomes:
Blood loss for adenoidectomy not separated from tonsillectomy

Choy 1992

Allocation:
Inadequate randomisation
Patient acted as own control

Flint 1980

Allocation:
Inadequate randomisation (hospital number)
Patient acted as own control

Haddow 2006

Outcomes:
No blinding of patient or outcome assessors

Haraldsson 2007

Allocation:
Patient acted as own control

Kousha 2007

Allocation:
Patient acted as own control

Lassaletta 1997

Allocation:
Inadequate randomisation (alternating)

Leach 1993

Allocation:
Unclear randomisation
Patient acted as own control

Linden 1990

Allocation:
High risk of performance bias
No information on intraoperative bleeding
Assessment of bleeding not blinded

MacGregor 1994

Allocation:
No randomisation

Mann 1984

Allocation:
Inadequate randomisation (social security number)
Patient acted as own control

Pang 1995

Allocation:
Unclear randomisation (there was also no blinding for pain/bleeding assessment)

Papangelou 1972

Allocation:
Not randomised

Phillipps 1989

Allocation:
Inadequate randomisation (alternating patients)

Pizzuto 2000

Outcomes:
Pain data not reported
Multiple outcome measures

Roy 1976

Allocation:
Non‐randomised, non‐blinded

Salam 1992

Allocation:
Inadequate randomisation (pack of cards)

Sengupta 1984

Allocation:
Inadequate randomisation (alternating cases)
Patient acted as own control

Tay 1995

Allocation:
Patient acted as own control

Tay 1996

Allocation:
Patient acted as own control

Watson 1993

Outcomes:
No intraoperative bleeding assessment
Assessment of postoperative bleeding not blinded

Weimert 1990

Allocation:
Unclear randomisation
Patient acted as own control

Wexler 1996

Allocation:
Inadequate randomisation (alternating patients)

Characteristics of studies awaiting assessment [ordered by study ID]

Ir a:

Bercin 2008

Methods

Randomisation

Participants

201 children (4 to 11 years)

Interventions

Bipolar cautery tonsillectomy versus classical dissection tonsillectomy

Outcomes

1. Intraoperative blood loss

2. Primary and secondary haemorrhage

3. Postoperative pain scores

4. Time to first solid food intake

Notes

Method of randomisation not described. No description of patient/family blinding. Deficient details of which assessors blinded for which outcomes. Attempts at contacting authors by email, fax and post so far unsuccessful.

Data and analyses

Open in table viewer
Comparison 1. Haemorrhage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intraoperative blood loss (ml) Show forest plot

2

250

Mean Difference (IV, Fixed, 95% CI)

‐21.56 [‐27.26, ‐15.85]
Analysis 1.1
Comparison 1 Haemorrhage, Outcome 1 Intraoperative blood loss (ml).

Comparison 1 Haemorrhage, Outcome 1 Intraoperative blood loss (ml).

2 Secondary haemorrhage Show forest plot

2

250

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.56 [0.19, 1.63]
Analysis 1.2
Comparison 1 Haemorrhage, Outcome 2 Secondary haemorrhage.

Comparison 1 Haemorrhage, Outcome 2 Secondary haemorrhage.
Open in table viewer
Comparison 2. Analgesic requirement

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Analgesic doses first 24 hours Show forest plot

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.36, 0.16]
Analysis 2.1
Comparison 2 Analgesic requirement, Outcome 1 Analgesic doses first 24 hours.

Comparison 2 Analgesic requirement, Outcome 1 Analgesic doses first 24 hours.

2 Analgesic doses over 12 days Show forest plot

1

47

Mean Difference (IV, Fixed, 95% CI)

7.50 [1.05, 13.95]
Analysis 2.2
Comparison 2 Analgesic requirement, Outcome 2 Analgesic doses over 12 days.

Comparison 2 Analgesic requirement, Outcome 2 Analgesic doses over 12 days.
Open in table viewer
Comparison 3. Activity level and diet

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days to normal activity Show forest plot

Other data

No numeric data
Analysis 3.1

Study

Diathermy

Dissection

Nunez 2000

Median 7.0 (95% CI 5.0 to 8.0)

Median 5.0 (95% CI 3.0 to 8.0)

Comparison 3 Activity level and diet, Outcome 1 Days to normal activity.

2 Days to normal diet Show forest plot

Other data

No numeric data
Analysis 3.2

Study

Diathermy

Dissection

Nunez 2000

Median 7.5 (95% CI 5.0 to 8.0)

Median 5.0 (95% CI 3.0 to 7.0)

Comparison 3 Activity level and diet, Outcome 2 Days to normal diet.

Comparison 1 Haemorrhage, Outcome 1 Intraoperative blood loss (ml).
Figuras y tablas -
Analysis 1.1

Comparison 1 Haemorrhage, Outcome 1 Intraoperative blood loss (ml).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Haemorrhage, Outcome 2 Secondary haemorrhage.
Figuras y tablas -
Analysis 1.2

Comparison 1 Haemorrhage, Outcome 2 Secondary haemorrhage.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Analgesic requirement, Outcome 1 Analgesic doses first 24 hours.
Figuras y tablas -
Analysis 2.1

Comparison 2 Analgesic requirement, Outcome 1 Analgesic doses first 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Analgesic requirement, Outcome 2 Analgesic doses over 12 days.
Figuras y tablas -
Analysis 2.2

Comparison 2 Analgesic requirement, Outcome 2 Analgesic doses over 12 days.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study

Diathermy

Dissection

Nunez 2000

Median 7.0 (95% CI 5.0 to 8.0)

Median 5.0 (95% CI 3.0 to 8.0)

Figuras y tablas -
Analysis 3.1

Comparison 3 Activity level and diet, Outcome 1 Days to normal activity.

Ir a la figura de la revisión

Study

Diathermy

Dissection

Nunez 2000

Median 7.5 (95% CI 5.0 to 8.0)

Median 5.0 (95% CI 3.0 to 7.0)

Figuras y tablas -
Analysis 3.2

Comparison 3 Activity level and diet, Outcome 2 Days to normal diet.

Ir a la figura de la revisión
Comparison 1. Haemorrhage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intraoperative blood loss (ml) Show forest plot

2

250

Mean Difference (IV, Fixed, 95% CI)

‐21.56 [‐27.26, ‐15.85]

2 Secondary haemorrhage Show forest plot

2

250

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.56 [0.19, 1.63]
Figuras y tablas -
Comparison 1. Haemorrhage
Ir a la tabla de la revisión
Comparison 2. Analgesic requirement

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Analgesic doses first 24 hours Show forest plot

1

50

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.36, 0.16]

2 Analgesic doses over 12 days Show forest plot

1

47

Mean Difference (IV, Fixed, 95% CI)

7.50 [1.05, 13.95]
Figuras y tablas -
Comparison 2. Analgesic requirement
Ir a la tabla de la revisión
Comparison 3. Activity level and diet

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days to normal activity Show forest plot

Other data

No numeric data

2 Days to normal diet Show forest plot

Other data

No numeric data
Figuras y tablas -
Comparison 3. Activity level and diet
Ir a la tabla de la revisión