Efficacy of pillar suture for post-tonsillectomy morbidity in children: a meta-analysis

Ji-Sun Kim, Byung Guk Kim, Dong-Hyun Kim, Se Hwan Hwang, Ji-Sun Kim, Byung Guk Kim, Dong-Hyun Kim, Se Hwan Hwang

Abstract

Introduction: Several surgical techniques have been used during tonsillectomy to reduce complications.

Objectives: To assess the effects of pillar suture in conjunction with tonsillectomy as compared to tonsillectomy without suture in children.

Methods: Two authors independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2018. Of the included studies, we compared tonsillectomy and pillar suture in combination (suture groups) with tonsillectomy alone,without suture, (control group). Postoperative pain intensity and other morbidities (e.g., postoperative bleeding, palatal hematoma, discomfort, and pillar edema) were measured during the postoperative period.

Results: Postoperative bleeding [primary (OR = 0.47 [0.27; 0.81]) and secondary (OR = 0.14 [0.02; 0.78]) were significantly decreased in the pillar suture group compared to the control group. There were no significant differences between the two groups in postoperative pain at day 7 (SMD = -0.39 [-0.79; 0.00]), palatal hematoma (OR = 5.00 [0.22; 112.88]), palatal discomfort sensation (OR = 2.62 [0.60; 11.46]), site infection (OR = 5.27 [0.24; 113.35]), and velopharyngeal insufficiency (OR = 2.82 [0.11; 74.51]). By contrast, pillar edema (OR = 9.55 [4.29; 21.29]) was significantly increased in the pillar suture group compared to the control group.

Conclusions: Pillar suture combined with tonsillectomy may reduce postoperative bleeding incidence despite increasing pillar edema in pediatric tonsillectomy. Postoperative pain-relief, palatal hematoma, palatal discomfort sensation, site infection, and velopharyngeal insufficiency were not significantly altered compared to tonsillectomy alone. However, further studies are needed to corroborate the results of this study.

Keywords: Meta-analysis; Pillar suture; Postoperative hemorrhage; Postoperative pain; Tonsillectomy.

Copyright © 2020 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Diagram of the selection of studies for meta-analysis.
Figure 2
Figure 2
Pillar suture versus control groups for postoperative pain on postoperative day 7. (TE, Treatment Effect; seTE, Standard Error of Treatment Effect; SMD, Standardized Mean Difference; CI, Confidence Interval).
Figure 3
Figure 3
Pillar suture versus control groups for postoperative bleeding. Odds Ratio of the incidence of primary postoperative bleeding (A) and secondary postoperative bleeding (B). (Total, Nnumber of participants per group; OR, Odds Ratio; CI, Confidence Interval).
Figure 4
Figure 4
Pillar suture versus control groups for postoperative adverse effects. Odds ratio of the incidence of pillar edema (A), palatal hematoma (B), palatal discomfort sensation (C), suture site infection (D), and velopharyngeal insufficiency (E). (Total, Number of participants per group; OR, Odds Ratio; CI, Confidence Interval).

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Source: PubMed

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