A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy

Background: Morbidity following tonsillectomy continues to be a major conce rn to parents, children, and physicians alike. Reduction in post-operative complications, optimal control of pain, and satisfactory return to a normal lifestyle are all important to both family and society. This study compare s both the complication and recovery rates after microbipolar dissection (M BPD) technique of tonsillectomy to two well established tonsillectomy techn iques: hot knife (HK) and cold knife/cautery (CK/C). Methods: A total of 20 0 consecutive patients presenting for tonsillectomy by the first author (MP ) were randomized to either undergo MBPD or HK tonsillectomy. Concurrently, an additional two hundred patients were randomized to undergo MBPD or CK/C tonsillectomy by the second author (LB). Patients were prospectively follo wed for complications including bleeding and dehydration and multiple indic ators of recovery rate. Results: Postoperative bleeding of any kind was sig nificantly less in the MBPD group than in the CK/C and HK groups (5 vs 12.4 vs 12.5% (P < 0.001). The need for post-operative intervention for bleedin g, i.e. local control or return to the operating room, was also significant ly less in the MBPD group. Return to normal activity occurred 2 days earlie r in the MBPD group versus either CK/C or HK (P < 0.001). Additionally, ear lier recovery was reflected in fewer total doses of pain medication in the MBPD group. Operative time was 3-5 min longer for MBPD (24.2 min) than for CK/C or HK (21.1 and 16.5 min, respectively); blood loss was similar (withi n 15 cc) among all treatment groups. Conclusion: MBPD tonsillectomy compare d most favorably to conventional techniques (CK/C and to HK tonsillectomy). Important clinical outcome differences included a lower bleed rate, earlie r recovery and fewer days lost from work and school. The financial impact i s estimated to be quite favorable. MBPD tonsillectomy is now our preferred method in children. (C) 2000 Elsevier Science Ireland Ltd. All rights reser ved.