Post-operative morbidity and 1-year outcomes in CO₂-laser tonsillotomy versus dissection tonsillectomy

Abstract

Objective: In this study a type of partial tonsil surgery, CO₂-laser tonsillotomy, was compared to regular tonsillectomy. The effectiveness and post-operative recovery rate of both interventions in adult patients was assessed by using a questionnaire.

Study design: Prospective follow-up non-randomized cohort study.

Method: One hundred and seven adults were included; 46 tonsillectomies and 61 tonsillotomies were performed. Patients in the tonsillectomy group underwent general anaesthesia, while tonsillotomy was performed in an ambulatory setting with local anaesthesia. Post-operative questionnaires were administered by mail after 2 weeks, 6 months, and 1 year to assess recovery rate and symptom recurrence.

Results: In total, 72.5% of patients were cured from their initial symptoms after tonsillotomy. Three patients (7.5%) required re-surgery for their initial complaints. After tonsillectomy, 97.2% of patients were cured. Both groups showed equally high satisfaction scores after treatment. Post-operative evaluation after 2 weeks showed a mean pain-intensity score of 5.4 (Visual Analogue Scale 0–10) after tonsillotomy and a mean pain-intensity score of 7.7 after tonsillectomy. The post-operative use of analgesics was twice as long in the tonsillectomy group compared to the tonsillotomy group and the tonsillectomy group required twice as many days for full recovery. After tonsillectomy a higher rate of major post-operative haemorrhage was seen.

Conclusion: CO₂-laser tonsillotomy is associated with a shorter and less painful recovery period. Both surgical methods are equal in terms of long-term satisfaction, although tonsillotomy comes with a higher recurrence rate of mild symptoms. A strict pre-operative patient selection for CO₂-laser tonsillotomy is necessary.

Keywords:

• Tonsillotomy
• tonsillectomy
• tonsil surgery
• laser in adults
• CO₂-laser
• recurrent tonsillitis
• tonsilloliths
• recovery
• symptoms
• complications

Acknowledgements

Special appreciation is extended to Dr H. P. Verschuur for the critical review and helpful comments. The authors thank the Department of Medical Statistics and Bio-informatics located in the Leids Universitair Medisch Centrum (LUMC) located in Leiden for their advice in data analysis. The authors also thank all patients who willingly participated in this study.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding information

This project was funded by HagaZiekenhuis and ENT-surgeons.