Pediatric tonsillectomy: post-operative morbidity comparing microsurgical bipolar dissection versus cold sharp dissection

Abstract

A prospective single-blinded study was conducted to compare pediatric tonsillectomy using the traditional cold sharp dissection with ligation for securing hemostasis (CSDL) versus microsurgical bipolar dissection technique (MBCT). Sixty children aged between 2 and 14 years were sequentially assigned to each group. Blood loss and postoperative pain in the first hour were markedly decreased in the MBCT group (P < 0.0001 and P < 0.05, respectively). Average surgical time was slightly decreased in diathermy tonsillectomy (15'30") compared with the cold technique (16'30"). Return to normal diet was significantly earlier in the CSDL group (P < 0.05). Late postoperative pain measured on the tenth day showed a moderate increase in children who underwent MBCT. There was no difference between the two techniques in the incidence of postoperative hemorrhage. No major complications occurred. We believe MBCT is a fast and safe technique which may be useful in children with known bleeding disorders. However, it increases late postoperative pain and, therefore, delay in patients' return to normal activities. Consequently, it does not represent a significant advantage over the traditional CSDL procedure.