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Children's Health

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Novel Tonsillectomy Cuts Pain, Bleeding

But Tonsils Can Grow Back After Surgery

Tonsillectomy: Old and New continued...

Just 3% of the intracapsular surgery patients required emergency room treatment for pain or dehydration caused by restricted fluid intake due to pain, compared with 5.4% of patients who had traditional surgery.

But 11 children (0.6%) in the intracapsular tonsillectomy group needed repeat tonsillectomies when tonsil tissue grew back.

This regrowth rate was in line with earlier reports suggesting that slightly more than one in 200 children who have the surgery require second tonsillectomies.

The study is published in the September issue of the journal Archives of Otolaryngology and Head and Neck Surgery.

Not All ENTs Convinced

Schmidt says the novel surgery should become the standard of care for children who require tonsil removal because of enlarged tonsils and adenoids. There is less research on outcomes among children whose indication for surgery is recurrent infection, or tonsillitis.

Pediatric head and neck surgeon David Darrow, MD, says he is not convinced that the benefits of intracapsular tonsillectomy outweigh the risk of a second tonsil surgery, regardless of the surgical indication.

He tells WebMD that he and a colleague recently conducted a similar comparison of outcomes with the intracapsular surgery and traditional tonsillectomy at the Norfolk, Va., hospital where he practices.

Children in that study who had the newer surgery also tended to have less pain and bleeding complications than children who had traditional tonsillectomies, but Darrow describes the differences as modest.

“Based on the results, my partner and I came to very different conclusions about this surgery,” he says. “He now does the new surgery routinely, but I was not convinced that the differences justified the risk of leaving tonsil tissue behind, so I don’t do it.”

He adds that the newer surgery should never be performed unless parents fully understand the benefits and risks.

Darrow is a professor of otolaryngology in pediatrics at Eastern Virginia Medical School. He also chairs the tonsil and adenoids subcommittee for the American Academy of Otolaryngology.

“Parents may be willing to risk the chance of a second surgery for less pain, but in the end it is their decision,” he says.

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