A Comparative Study of Dissection and Snare and Electrocautery Techniques of Tonsillectomy- A Randomised Clinical Trial MC01-MC03
Dr. Abhay D Havle,
Department of Otorhinolaryngology, Krishna Institute of Medical Sciences Deemed to be University, Karad-415110, Maharashtra, India.
Introduction: Tonsillectomy is the preferred surgical modality in chronic tonsillitis or kissing tonsils, globally. Since, many years tonsillectomy is performed using various methods. The ancient Guillotine method of tonsillectomy is obsolete nowa-days whereas, the dissection and snare and electrocautery techniques are in use since late 1960â€™s. Thus, this study was attempted to evaluate the advantages and disadvantages between these two techniques.
Aim: To compare and find the advantages and disadvantages between dissection and snare, and electrocautery techniques of tonsillectomy amongst a rural population of western Maharashtra, India.
Materials and Methods: A randomised comparative study of 50 clinically diagnosed cases of chronic tonsillitis that required tonsillectomy was conducted. All cases were randomised into group-I, II and subjected to tonsillectomy using dissection and snare, and electrocautery methods respectively after prior routine investigations. Intra-operative blood loss, duration of surgery, assessment of postoperative pain, total duration of hospitalisation and any other complication and its management as well as condition of tonsillar fossa were noted in all cases after surgery and during follow-up period of 10 days postsurgery. The mean postoperative pain, intra-operative blood loss and total duration of hospitalisation were compared using Mann-Whitney U-test. The mean duration of operating time was compared by Studentâ€™s t-test. Dose comparison of analgesic and extended haemostatic measure required were compared by Chi-square test.
Results: Mean intra-operative blood loss was significantly less after using electrocautery. The mean postoperative pain was significantly less after dissection and snare method. The mean duration of surgery was significantly less after using electrocautery. The mean duration of hospitalisation, the extended postoperative procedure required was more after electrocautery method however, it was not statistically significant. There was no significant difference in postoperative tonsillar fossa healing in either group during follow-up period of 7-10 days.
Conclusion: Even though, the overall advantages of using dissection and snare method was more as compared to electrocautery, the important advantages that would lessen the morbid situations like excessive intra-operative blood loss and duration of surgery and anaesthesia were associated with latter.