Revisiting the Hot versus Cold Debate: A Contemporary Comparison of Monopolar Diathermy-Assisted and Cold Steel Tonsillectomy

Introduction: Tonsillectomy, a common surgery, uses either "cold" (steel) or "hot" (diathermy) dissection. Diathermy shortens the time needed for surgery and cuts down on bleeding during surgery, but it can also produce thermal damage, which makes pain worse after surgery, slows recovery, and raises the risk of subsequent bleeding. On the other hand, cold dissection keeps the tissue intact but makes main bleeding worse. Because each procedure has its own pros and downsides when it comes to patient comfort and surgical efficiency, there is no one right answer. This suggested study aims to conclusively compare different strategies within the ongoing debate and enhance patient safety outcomes. Material and methods: This was a prospective, observational study to compare the morbidity of electrocautery (hot) dissection tonsillectomy versus cold dissection tonsillectomy in children aged 5 to 15 years presenting with recurrent tonsillitis or symptomatic adeno-tonsillar hypertrophy. Results: This study compared hot (diathermy) and cold dissection tonsillectomy in 60 matched children (30 per group). Intraoperatively, hot dissection demonstrated clear advantages, significantly reducing mean blood loss (5.0 mL vs. 43.7 mL) and haemostasis time (5.1 mins vs. 16.4 mins). However, postoperative recovery favoured the cold dissection group. While immediate hospital pain scores were similar, children undergoing hot dissection required significantly more analgesic doses over a 15-day recovery period (31.7 vs. 23.2 doses) and experienced a clinically significant 3.5-day delay in returning to a normal solid diet (9.5 days vs. 6.0 days). Conclusion: This study finds that although hot (electrocautery) tonsillectomy creates a bloodless surgical field, it substantially impairs paediatric home recovery, resulting in heightened discomfort, a postponed return to eating, and an increase in medical visits owing to thermal injury. Therefore, traditional cold steel dissection remains superior for minimizing patient suffering. Key words: Paediatric Tonsillectomy, Monopolar Diathermy, Post-op analgesia, Post op hemorrhage