Coblation intracapsular tonsillectomy in children: A prospective study of 1257 consecutive cases with long-term follow-up

Objectives: Intracapsular tonsillectomy (ICT) is increasingly adopted by paediatric centres worldwide due to its association with reduced pain, fast recovery and low risks of post-operative complications. Questions still surround its role in patients with recurrent tonsillitis, as well as tonsillar regrowth requiring revision surgery.

Design: Prospective consecutive case series from March 2013 to April 2020.

Setting: Tertiary paediatric ENT referral centre.

Participants: Paediatric patients undergoing Coblation ICT, with or without adenoidectomy, for obstructive and/or infective indications.

Main outcome measures: Health-Related Quality of Life (HRQL), analgesia requirement, post-operative haemorrhage rates, time to return to normal diet and activity or school/nursery, and parental satisfaction. We report revision surgery rates and identify predictive factors for revision surgery.

Results: A total of 1257 patients (median age 4.2 years) underwent Coblation ICT, with a median direct and implied follow-up of 101.5 and 1419 days, respectively. We noted significantly improved HRQL scores across all domains. Median analgesia requirement was six days, and no patients required a return to theatre for post-operative haemorrhage. The majority of patients were eating a normal diet within 24 hours and returned to normal activity/school within a week post-operatively. Revision surgery was required in 2.6% of cases, mainly due to recurrent obstructive symptoms from tonsillar regrowth. Being under two years old at initial surgery (OR 5.10), having severe OSA (OR 4.43) or severe comorbidities (OR 2.98) increased the risk of needing revision surgery.

Conclusions: Long-term data demonstrate the efficacy and safety of Coblation ICT in paediatric patients across a range of indications.