The authors stated that 11 RCTs were included, but only 10 RCTs (n=1,258) were presented in the tables and referred to in the text.
The studies were poorly reported. Two studies were awarded a B grade and the others a C grade. All of the studies were underpowered, and the majority did not define primary and secondary haemorrhage. Potential confounding factors included the selection of patients, additional haemostatic interventions and expertise of the surgeon.
HST versus cold steel tonsillectomy (5 studies, n=508): all of the studies used a ‘hot’ haemostatic method to control bleeding in the cold steel group. One study reported no significant difference in the proportion returned to theatre. One study reported a significant reduction in secondary haemorrhage in patients in the HST group (p=0.01), whereas another study reported no significant difference in this outcome between treatments. Statistical significance was not reported for the other 3 studies.
HST versus ‘hot’ tonsillectomy (5 studies, n=750): the studies reported no significant difference in secondary haemorrhage between HST and bipolar scissors (1 study), no significant difference in post-operative bleeding between HST and monopolar cautery plus coblator (1 study), and no difference in rate of return to theatre for secondary haemorrhage between HST and electrocautery (2 studies). One study reported the same number of secondary tonsillar bleeds in patients allocated to HST and bipolar diathermy.