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Objectives <p>To compare postoperative outcomes of subtotal (intracapsular) and total (extracapsular) tonsillectomy in adults with chronic tonsillopharyngitis, with focus on pain, primary (&lt; 24&#xa0;h) and secondary (2nd to 14th postoperative day) hemorrhage, hospital stay, and recurrence, and to evaluate the influence of surgical technique (coblation vs. cold dissection).</p> Design <p>Retrospective descriptive-analytical study.</p> Setting <p>Department of Otolaryngology, Ketteler Hospital, Offenbach, Germany.</p> Participants <p>Ninety-seven adults (18–60 years) undergoing subtotal or total tonsillectomy between 2016 and 2021, stratified into four subgroups: subtotal–coblation, subtotal–cold dissection, total–coblation, and total–cold dissection.</p> Main outcome measures <p>Postoperative pain (VAS and WHO scale), primary and secondary hemorrhage, hospital stay, reoperation, and antibiotic use.</p> Results <p>Subtotal tonsillectomy was associated with significantly lower pain scores (<i>P</i> = 0.031) and shorter hospital stay (mean 1.24 ± 0.66 days) compared with total tonsillectomy (mean 4.25 ± 1.25 days, <i>P</i> &lt; 0.001). Coblation also reduced pain compared with cold dissection (<i>P</i> = 0.044). Primary hemorrhage rates did not differ significantly between subtotal and total procedures (6.3% vs. 11.9%, <i>P</i> = 0.28) or between surgical techniques (<i>P</i> = 0.52). In contrast, secondary hemorrhage was more frequent after total tonsillectomy (10.0% vs. 0%, <i>P</i> = 0.004), highest in the total–coblation group (14.6%) and absent in subtotal–cold dissection cases (<i>P</i> = 0.010 for four-group comparison). Reoperation (7.2%) and postoperative antibiotic use showed no significant intergroup differences.</p> Conclusions <p>Subtotal tonsillectomy, particularly when performed with coblation, offers advantages of reduced pain, shorter hospitalization, and lower secondary bleeding risk compared with total tonsillectomy, while maintaining comparable safety regarding primary hemorrhage. These findings support subtotal tonsillectomy as a less invasive, patient-centered alternative in selected adults, although prospective multicenter studies are required to confirm long-term and recurrence outcomes.</p>

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Comparative evaluation of subtotal and total tonsillectomy in the management of chronic tonsillopharyngitis in adults

  • 期刊论文

  • 发表日期：

    2025年11月1日

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  • Seied-Reza Seied-Mohammad Doulabi,
  • Alireza Moradi,
  • Knut Engels,
  • Susanne Kriener,
  • Ashkan Sherafat Vaziri,
  • Mehran Baghi

摘要

Objectives

To compare postoperative outcomes of subtotal (intracapsular) and total (extracapsular) tonsillectomy in adults with chronic tonsillopharyngitis, with focus on pain, primary (< 24 h) and secondary (2nd to 14th postoperative day) hemorrhage, hospital stay, and recurrence, and to evaluate the influence of surgical technique (coblation vs. cold dissection).

Design

Retrospective descriptive-analytical study.

Setting

Department of Otolaryngology, Ketteler Hospital, Offenbach, Germany.

Participants

Ninety-seven adults (18–60 years) undergoing subtotal or total tonsillectomy between 2016 and 2021, stratified into four subgroups: subtotal–coblation, subtotal–cold dissection, total–coblation, and total–cold dissection.

Main outcome measures

Postoperative pain (VAS and WHO scale), primary and secondary hemorrhage, hospital stay, reoperation, and antibiotic use.

Results

Subtotal tonsillectomy was associated with significantly lower pain scores (P = 0.031) and shorter hospital stay (mean 1.24 ± 0.66 days) compared with total tonsillectomy (mean 4.25 ± 1.25 days, P < 0.001). Coblation also reduced pain compared with cold dissection (P = 0.044). Primary hemorrhage rates did not differ significantly between subtotal and total procedures (6.3% vs. 11.9%, P = 0.28) or between surgical techniques (P = 0.52). In contrast, secondary hemorrhage was more frequent after total tonsillectomy (10.0% vs. 0%, P = 0.004), highest in the total–coblation group (14.6%) and absent in subtotal–cold dissection cases (P = 0.010 for four-group comparison). Reoperation (7.2%) and postoperative antibiotic use showed no significant intergroup differences.

Conclusions

Subtotal tonsillectomy, particularly when performed with coblation, offers advantages of reduced pain, shorter hospitalization, and lower secondary bleeding risk compared with total tonsillectomy, while maintaining comparable safety regarding primary hemorrhage. These findings support subtotal tonsillectomy as a less invasive, patient-centered alternative in selected adults, although prospective multicenter studies are required to confirm long-term and recurrence outcomes.