Comparing post-operative outcomes between tonsillectomy with and without inferior suturing tonsil pillars, A randomized controlled trial
Keywords:
tonsillectomy, inferior suturing of the tonsil pillars technique, post tonsillectomy painAbstract
Background: Tonsil surgery is a common procedure in Otorhinolaryngology and is often associated with postoperative pain. Various treatments and surgical techniques have been employed to alleviate postoperative pain, but the most effective approach remains uncertain.
Objective: This study aimed to compare the effectiveness of inferior suturing of the tonsil pillars technique versus not using the technique in reducing postoperative pain, postoperative bleeding, postoperative infection, and length of hospital stay in adult patients undergoing tonsillectomy.
Methods: A randomized controlled trial was conducted during October 2019 -October 2022, the study included patients aged over 15 years who required tonsillectomy surgery while exclusion criteria included patients who had undergone concurrent surgeries, communication difficulties, or peritonsillar abscess. Sample randomization was conducted using a random block of four, and allocation was concealed within opaque envelopes which was opened in the operation room after tonsil removal. In the study group, patients received sutures of the inferior tonsillar pillar. Pain scores on days 0, 1, 2, 3, 7, and 14 post-operations were assessed by blinded assessors using a 10-point visual analog scale (VAS). Additionally, pain levels, paracetamol consumption, intraoperative blood loss, operation time, postoperative surgical site infections, and length of hospital stay were recorded. Statistical analyses, including Fisher's Exact test, T-Test, Rank sum test and multilevel mixed effects models, linear regression model were applied.
Results: The study included a total of 31 patients, with 16 in the study group and 15 in the control group. The male sex distribution was 81.3% and 33.3%, mean ages of 30.7 ± 8.7 and 28.9 ± 9.7, respectively. The study group exhibited significantly lower median pain scores on day 0 (5.5 ± 1.5) and day 1 (4 ± 3) (p = 0.005) compared to the control group. Both groups had comparable rates of postoperative blood loss, bleeding, and infection. The median length of hospital stay was 2 ± 1 days in the study group and 3 ± 1 days in the control group (p = 0.533), while the operation time was 45.9 ± 2.4 minutes in the study group and 34.5 ± 3.4 minutes in the control group (p = 0.009).
In conclusion, this study suggests that inferior suturing of the tonsil pillars in patients undergoing tonsillectomy can reduce pain scores in the early postoperative period.
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