Intracapsular vs Extracapsular Coblation Tonsillectomy: Comparative Efficacy

ABSTRACT: This narrative review evaluates whether intracapsular coblation tonsillectomy is more effective than extracapsular coblation tonsillectomy in reducing postoperative pain and complications. We screened 20 studies focusing exclusively on coblation techniques that clearly documented surgical methods and reported relevant clinical outcomes. After applying strict eligibility criteria, 15 studies were included comprising randomized controlled trials, prospective cohorts, retrospective studies, and systematic reviews/meta-analyses. The findings consistently demonstrate that intracapsular coblation tonsillectomy is associated with significantly lower postoperative pain scores, quantified by various methods including Visual Analog Scale, Wong-Baker FACES, and standardized mean differences, particularly during the first postoperative week. Recovery timelines were faster in the intracapsular group, with earlier return to normal diet and activity by 2.8–5.5 days. Hemorrhage rates were lower in the intracapsular technique, with primary bleeding rates ranging from 0% to 0.3% compared to up to 2.8% in the extracapsular group, and risk ratios consistently favored intracapsular approaches. Revision rates were slightly higher for intracapsular procedures but remained low and did not affect overall morbidity. The majority of studies focused on pediatric populations, though adult studies reported similar trends. These findings highlight the clinical advantages of intracapsular coblation tonsillectomy, suggesting improved postoperative outcomes with reduced pain and bleeding complications. However, heterogeneity in study design and reporting practices limit the strength of conclusions. This review emphasizes the need for high-quality randomized trials to establish definitive practice guidelines. Keywords: Tonsillectomy, Coblation, Postoperative Pain, Postoperative Complications, Pediatric Surgery