Adjunctive pillar suturing or pharyngoplasty in pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis.

OBJECTIVE

To evaluate whether pillar suturing or pharyngoplasty added to tonsillectomy with or without adenoidectomy provides additional benefit in children with obstructive sleep apnea (OSA).

DATA SOURCES: PubMed, Embase, and the Cochrane Library were systematically searched from database inception to October 2025.

REVIEW

METHODS

Randomized controlled trials and nonrandomized comparative studies comparing tonsillectomy with adjunctive pharyngoplasty or pillar suturing versus tonsillectomy alone in pediatric OSA were included. Primary outcomes were polysomnography-derived parameters, including apnea-hypopnea index (AHI), oxygen desaturation index, respiratory disturbance index, and minimum oxygen saturation. Secondary outcomes included OSA-18 scores, clinical efficacy, and postoperative complications. Pooled analyses were performed using random-effects models.

RESULTS

Eleven studies were included. Meta-analysis showed no significant difference in postoperative AHI between groups (mean difference, 2.22 events/hour; 95% CI, -4.36 to 8.80). No significant differences were observed in postoperative AHI <1 event/hour (odds ratio [OR], 0.75; 95% CI, 0.33 to 1.72), surgical success, or OSA-18 scores. Postoperative hemorrhage risk was also comparable (OR, 0.50; 95% CI, 0.13 to 1.89). Sensitivity analyses excluding studies enrolling children with Down syndrome yielded consistent findings.

CONCLUSION

Current evidence does not demonstrate a consistent additional benefit of adjunctive pharyngoplasty or pillar suturing in pediatric OSA surgery. These findings do not support routine adjunctive pharyngeal suturing and underscore the importance of individualized surgical decision-making.