Thermal welding tonsillectomy versus cold dissection tonsillectomy: A systematic review and meta‐analysis of randomised controlled trials

Abstract

AbstractObjectivesTo evaluate the efficacy of thermal welding (TW) versus cold dissection (CD) strategies among tonsillectomy patients.Design and SettingA systematic review and meta‐analysis of randomised controlled trials (RCTs).ParticipantsPatients undergoing tonsillectomy.Main Outcome MeasuresThe outcomes were summarised as risk ratio (RR) or mean difference/standardised mean difference (MD/SMD) with 95% confidence interval (CI) in a random‐effects model.ResultsFourteen RCTs were analysed. The mean operative time (n = 14 RCTs, MD = −7.99 min, 95% CI [−12.88, −3.10], p < .001), mean intraoperative blood loss (n = 11 RCTs, MD = −57.18 mL, 95% CI [−71.58, −42.78], p < .001) and postoperative pain score on day 1 (n = 15 RCTs, SMD = −0.40, 95% CI [−0.75, −0.06], p = .02) were significantly reduced in the TW group compared with the CD group. However, there was no significant difference between both groups regarding the rate of reactionary bleeding (n = 13 RCTs, RR = 0.62, 95% CI [0.23, 1.71], p = .36) and delayed bleeding (n = 13 RCTs, RR = 1.03, 95% CI [0.46, 2.30], p = .95).ConclusionCompared with CD, TW significantly reduced the operative time and intraoperative blood loss, without an impact on the rate of postoperative bleeding. The reduction in postoperative pain score provided by the TW strategy was not clinically meaningful in clinical practice. TW might appear superior to CD among tonsillectomy patients.