Authors' recommendations: Since 2002, five children have died as a result of extracapsular dissections performed in Québec. This brief is designed to inform the different stakeholders concerned by the coroner's inquests into the two most recent deaths. It contains a literature review on intracapsular dissections and on the parameters that could facilitate the identification of children at risk for hemorrhage caused by tonsil surgery. The following conclusions were drawn. Standard extracapsular dissections and intracapsular dissections generally have equivalent effectiveness, with a relatively negligible risk of regrowth. They also have similar operating times. Moreover, there does not seem to be any clinical indication specific to intracapsular dissections. Compared with extracapsular dissections, intracapsular dissections nevertheless have largely the benefit of leading to significantly faster pain relief with significantly lower use of analgesics and a significantly earlier return to normal diet and activity. At worst, there is no significant difference between the procedures. Furthermore, intracapsular dissections cause significantly lower rates of infection and of secondary postoperative hemorrhage than those resulting from extracapsular dissections. Concerning other hemorrhages, primary hemorrhage rates are, at worst, equivalent for both procedures, whereas the rare results regarding the volume of blood loss during surgery remain ambiguous. Lastly, intracapsular dissections may have positive effects on the healthcare system because they are associated with such factors as a significantly lower mean time spent in the recovery room compared with that for extracapsular dissections and a reduced number of patients needing medical appointments because of pain. The results must of course be qualified considering the limitations of the studies, including the often too small sample size, the often too short follow-up period, the heterogeneous study methodologies, and the risk of publication bias. Nevertheless, a body of evidence favours intracapsular dissections (partial tonsillectomies and subtotal tonsillectomies) based on their effectiveness and safety, the positive effects they have on the healthcare system, as well as the marked reintroduction of these procedures in Western European countries. Given that it is ultimately quite challenging to establish the parameters or factors that could facilitate the identification of children at risk for hemorrhage, performing intracapsular dissections seems to be a concrete way of reducing patients' health risks and pain. In light of this assessment, it is therefore advisable to create a new surgical procedure code designating intracapsular dissection (partial tonsillectomy or subtotal tonsillectomy) with or without adenoidectomy.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/en/publications/publications/publication.html?PublicationPluginController%5Bcode%5D=FICHE&PublicationPluginController%5Buid%5D=434&PublicationPluginController%5BbackUrl%5D=%252Fnc%252Fen%252Fpublications%252Fpublications.html&cHash=2ff44d5e37364ab2c0fe20c4ac01548a

Year Published: 2016

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Chirurgie/INESSS_Chirurgie_amygdales.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: ©Gouvernement du Québec/Institut national d'excellence en santé et en services sociaux