A prospective double-blind randomized controlled trial comparing the suitability of KTP laser tonsillectomy with conventional dissection tonsillectomy for day case surgery.
Tonsillectomy using a KTP laser has been performed increasingly but is not a routinely practised technique in the UK. In the USA, tonsillectomy is often performed as a day case procedure but, here in the UK, it is still standard practice to admit patients for overnight stay. We present the largest prospective double-blind randomized controlled trial to date (151 patients) comparing KTP laser with standard dissection tonsillectomy and assess the suitability of both procedures for day case surgery. We found that there was significantly less peroperative haemorrhage if tonsillectomy was performed using the KTP laser, but it did cause more postoperative pain, more depression in mood and a higher rate of both reactionary and secondary haemorrhage, which was not significant when compared with conventional dissection. There was no difference in operating time, and over 40% of patients in each group needed overnight admission. We conclude that KTP laser tonsillectomy offers no benefit apart from less intraoperative bleeding over standard dissection tonsillectomy. Discharge from hospital after tonsillectomy was found to be unpredictable. Tonsillectomy is therefore an unsuitable procedure for planned surgery through a day unit, but approximately 58% of patients could be discharged on the same day from an extended day surgery unit, and the rest have one night in hospital.
Kothari
P
P
Department of Otolaryngology & Head and Neck Surgery, Milton Keynes General Hospital, Milton Keynes, UK.
Patel
S
S
Brown
P
P
Obara
L
L
O'Malley
S
S
D000293:Adolescent; D000339:Affect; D000556:Ambulatory Surgical Procedures; D016063:Blood Loss, Surgical; D004311:Double-Blind Method; D006801:Humans; D053685:Laser Therapy; D007902:Length of Stay; D010149:Postoperative Pain; D010359:Patient Readmission; D011183:Postoperative Complications; D011446:Prospective Studies; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*