Conventional versus endoscopic-assisted adenoidectomy : a comparative study

الملخص EN

Background : adenoidectomy is the surgical procedure to remove the adenoids.

It is conventionally performed using the curettage method.

The aim : is to compare between conventional and endoscopic–assisted method regarding safety and efficiency.

Patients and methods : from September 2010 to October 2011 , 40 patients (16 males and 24 females), requiring adenoidectomy were randomized into two groups each of twenty.

Group A underwent conventional adenoidectomy using the curettage method and Group B underwent trans-nasal endoscopic adenoidectomy using microdebrider.

The parameters studied were intra-operative time, complete resection, associated trauma, velopharyngeal dysfunction, residual remnant, post-operative bleeding, infection, and post-operative symptomatic relief.

Exclusion criteria include : post-operative pain and the amount of blood loss because the majority of patients underwent additional tonsillectomy.

Telephone questionnaire was used to follow up any symptomatic recurrence.

Results : after a short period of follow –up ,the time taken in Group A (conventional surgery) varied from 10-35 minutes [with a mean= 32.25 minutes ] ( 95 % CI 20.004-26.496) (P < 0.001) and in Group B (endoscopic method) from 20-90 minutes [with a mean of 42.75 minutes] (95 % CI 43.097-15.604) .The resection was almost complete in group B whereas in group A four cases (20 %) had residual adenoid tissue(95 % CI _0.3895-_ 0.0141) (P < 0.035).associated trauma in Group A found in 3 cases (15 %) all are minor involving the uvula and posterior pharyngeal wall whereas in Group B trauma occurs in 5 cases (25 %), 3 are minor involving septal mucosal injuries while 2 cases (10 %) required nasal packing(P > 0.05).

.Velopharyngeal dysfunction developed in 2 cases (10 %) of Group A and 3 cases(15 %) of Group B, all are resolved spontaneously within a week and not required any treatment (95% CI _0.0155-0.255) (P > 0.05).Infection complicated 1 cases (5 %) of Group A and 1 case of Group B(95 % CI _0.1479-0.3479) (P > 0.05) .Retained swab complicated 1 case (5 %) of Group A whereas none in Group B.

The overall complication rate in Group A was 55% whereas in Group B 45 %.

Conclusion : endoscopic–assisted Adenoidectomy is a safe and effective alternative to curettage method as it allow complete removal of adenoid tissue under direct vision .It is recommended to perform endoscopic–assisted surgery even with curettage method when possible.