(1025) Extracapsular Tonsillectomy With Coblation Versus Monopolar Electrocautery in Pediatric Patients: A Systematic Review and Meta-analysis

Introduction: Monopolar electrocautery (ME) is a commonly used instrument for extracapsular tonsillectomy given its excellent hemostasis, precision, and low cost. More recently, coblation has gained popularity as some studies have suggested a reduction in postoperative adverse events and improved overall morbidity in comparison to ME. In order to assess the differences in these techniques, we conducted a systematic review and meta-analysis to compare the outcomes of coblation versus ME in pediatric patients undergoing extracapsular tonsillectomy.

Methods: MEDLINE, Embase, Web Of Science, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing coblation and ME tonsillectomy in children. The outcomes of interest included visual analog scale (VAS) for pain, days using pain medication, post-tonsillectomy hemorrhage (PTH) rates, and operative time. Risk ratio (RR) and mean difference (MD) were used for binary and continuous outcomes, respectively.

Results: In total, 646 patients comprising 6 RCTs were included, of which 367 (56.8%) underwent extracapsular CT. Compared to ME tonsillectomy, coblation significantly decreased pain assessed through VAS during the first postoperative day (MD -1.39; 95% confidence interval [CI] -1.66 to -1.12; p < 0.00001) and days using pain medication (MD -1.60; 95% CI -2.23 to -0.97; p < 0.0001). There was no significant difference between groups for PTH (RR: 1.74; 95% CI 0.53-5.72; p = 0.36), and operative time (MD 0.5; 95% CI -4.87-5.88; p = 0.85).

Conclusions: Our findings suggest that in children undergoing extracapsular tonsillectomy, use of coblation was associated with less postoperative pain and pain medication use than ME, with similar PTH rates.