Effect of tonsillar fossa suturing in adolescents and adults: a systematic review and meta-analysis.

PURPOSE: Tonsillectomy is one of the most frequently performed surgical procedures in otolaryngology. Postoperative hemorrhage (PTH) and pain remain major concerns, particularly in adolescents and adults, in whom complications are more severe. The role of tonsillar fossa suturing after tonsillectomy in reducing these complications is still controversial.

METHODS

We conducted a comprehensive search of PubMed, Embase, and the Cochrane Library for studies comparing tonsillectomy with suturing (TS) versus without suturing (TNS) in patients older than 10 years.

RESULTS

Seven studies involving 3051 patients were included. Meta-analysis showed that TS significantly reduced the risk of overall PTH (odds ratio [OR], 0.329; 95% confidence interval [CI], 0.145-0.751), primary PTH (OR, 0.140; 95% CI, 0.036-0.540), secondary PTH (OR, 0.310; 95% CI, 0.174-0.552), and minor PTH (OR, 0.193; 95% CI, 0.086-0.429). No significant difference was observed for major PTH (OR, 0.550; 95% CI, 0.138-2.187). Regarding postoperative pain, a possible delayed difference was observed, with lower pain scores in the TS group on postoperative day 7 (mean difference [MD], - 1.646; 95% CI, - 3.202 to - 0.090), whereas scores on days 1, 2, 3, and 14 were comparable between groups.

CONCLUSION

These findings suggest that, in adolescents and adults, TS is associated with a reduced risk of PTH. Pain-related outcomes were exploratory and based on limited data. To our knowledge, this is the first meta-analysis focused on this higher-risk population, providing evidence to inform surgical decision-making.