<p>Adenoidectomy is a common paediatric surgical procedure for managing obstructive sleep apnea, recurrent otitis media, and nasal obstruction caused by adenoid hypertrophy. While traditional curettage remains widely practiced, its limitations, including incomplete tissue removal and higher recurrence rates, have driven the development of advanced techniques such as microdebrider-assisted adenoidectomy (MDA), coblation, and endoscopic-assisted adenoidectomy. A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and Cochrane Library databases were searched for studies published between 2000 and 2023 comparing adenoidectomy techniques. Data on efficacy, morbidity, and patient-centered outcomes were extracted from 15 eligible studies comprising 2,350 patients. Statistical analyses included odds ratios (ORs) and mean differences (MDs), with subgroup analysis for age-specific outcomes. Endoscopic-assisted adenoidectomy demonstrated the lowest recurrence rate (2.1%) and highest completeness of resection (96%), while coblation showed the least morbidity, with minimal intraoperative blood loss (4.0 mL) and pain scores (VAS: 2.8). Both techniques significantly improved patient satisfaction (mean scores: 9.2 and 8.7, respectively) and recovery times (4–5 weeks). Younger age (&lt; 6 years) and higher postoperative pain were identified as predictors of recurrence. Advanced adenoidectomy techniques outperform traditional curettage in reducing recurrence rates, improving surgical precision, and enhancing patient satisfaction. However, barriers such as high costs and specialized training requirements limit their widespread adoption. Future research should prioritize long-term outcomes and cost-effectiveness analyses to support broader implementation.</p>