Scholarlink

<p>Childhood tonsillar diseases, including recurrent tonsillitis and obstructive sleep-disordered breathing, significantly impact pediatric quality of life. While traditional cold steel tonsillectomy is effective, it is associated with considerable bleeding, postoperative pain, and prolonged recovery. Energy-based surgical techniques, including ultrasonic devices and bipolar diathermy, have been developed to enhance surgical precision and outcomes. However, the comparative effectiveness and safety of these techniques remain unclear. This systematic review and meta-analysis aim to evaluate and compare the clinical outcomes of ultrasonic device tonsillectomy and bipolar diathermy tonsillectomy in pediatric patients. A comprehensive literature search was conducted in PubMed, Scopus, Cochrane Library, Web of Science, and Embase. Randomized controlled trials (RCTs) comparing ultrasonic tonsillectomy with bipolar diathermy tonsillectomy in children were included. Data extraction focused on intraoperative blood loss, postoperative pain, and recovery outcomes. The Risk of Bias 2 (ROB 2) tool was used for quality assessment, and meta-analysis was performed using RevMan version 5.4.1 to estimate mean differences (MD) for mean blood loss and standardized mean difference (SMD) for post operative pain with 95% confidence intervals (CIs). Four studies with sample sizes ranging from 38 to 204 pediatric patients met the inclusion criteria. The mean blood loss outcome showed no significant difference between ultrasonic and bipolar diathermy tonsillectomy (MD = 2.78, 95% CI [− 1.10 to 6.65, <i>p</i> = 0.16], with heterogeneity, <i>p</i> = 0.0001, I² = 89%). For postoperative pain outcome showed significant difference between techniques operative time point favouring Ultrasonic Device (SMD = − 0.65, 95% CI [− 1.07 to − 0.24], <i>p</i> = 0.002) on day 1; (SMD = − 0.41, 95% CI [− 0.68 to − 0.14], <i>p</i> = 0.003) on day four. Moderate heterogeneity on day one (I² = 52%) and none on day four (I² = 0%). Both ultrasonic and bipolar diathermy tonsillectomy techniques are viable options for pediatric patients, with no clear advantage in terms of intraoperative blood loss, but early postoperative pain was lower with the ultrasonic device at day 1 and day 4. Given the variability in outcomes and study designs, individualized surgical decision-making is essential. Further high-quality RCTs are needed to establish definitive recommendations for optimizing pediatric tonsillectomy outcomes.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Comparative Efficacy and Safety of Ultrasonic Device Versus Bipolar Diathermy Tonsillectomy in Pediatric Patients: A Systematic Review and Meta-analysis

  • 期刊论文

  • 发表日期：

    2025年11月28日

查看全文
  • Mohammad Al Diab Al Azzawi,
  • Haya Z. Albalawi,
  • Rehaf Abdulrhman Areeshi,
  • Nesrin H. Eshaq,
  • Ibhar S. Idris,
  • Ahmed Ibrahim Alnajjad,
  • Omer Bader Aldayhani,
  • Razan M. Althumali,
  • Wafa Elnaseeh

摘要

Childhood tonsillar diseases, including recurrent tonsillitis and obstructive sleep-disordered breathing, significantly impact pediatric quality of life. While traditional cold steel tonsillectomy is effective, it is associated with considerable bleeding, postoperative pain, and prolonged recovery. Energy-based surgical techniques, including ultrasonic devices and bipolar diathermy, have been developed to enhance surgical precision and outcomes. However, the comparative effectiveness and safety of these techniques remain unclear. This systematic review and meta-analysis aim to evaluate and compare the clinical outcomes of ultrasonic device tonsillectomy and bipolar diathermy tonsillectomy in pediatric patients. A comprehensive literature search was conducted in PubMed, Scopus, Cochrane Library, Web of Science, and Embase. Randomized controlled trials (RCTs) comparing ultrasonic tonsillectomy with bipolar diathermy tonsillectomy in children were included. Data extraction focused on intraoperative blood loss, postoperative pain, and recovery outcomes. The Risk of Bias 2 (ROB 2) tool was used for quality assessment, and meta-analysis was performed using RevMan version 5.4.1 to estimate mean differences (MD) for mean blood loss and standardized mean difference (SMD) for post operative pain with 95% confidence intervals (CIs). Four studies with sample sizes ranging from 38 to 204 pediatric patients met the inclusion criteria. The mean blood loss outcome showed no significant difference between ultrasonic and bipolar diathermy tonsillectomy (MD = 2.78, 95% CI [− 1.10 to 6.65, p = 0.16], with heterogeneity, p = 0.0001, I² = 89%). For postoperative pain outcome showed significant difference between techniques operative time point favouring Ultrasonic Device (SMD = − 0.65, 95% CI [− 1.07 to − 0.24], p = 0.002) on day 1; (SMD = − 0.41, 95% CI [− 0.68 to − 0.14], p = 0.003) on day four. Moderate heterogeneity on day one (I² = 52%) and none on day four (I² = 0%). Both ultrasonic and bipolar diathermy tonsillectomy techniques are viable options for pediatric patients, with no clear advantage in terms of intraoperative blood loss, but early postoperative pain was lower with the ultrasonic device at day 1 and day 4. Given the variability in outcomes and study designs, individualized surgical decision-making is essential. Further high-quality RCTs are needed to establish definitive recommendations for optimizing pediatric tonsillectomy outcomes.