Adding a pharyngeal procedure to children's sleep-apnoea surgery did not help

Design

Systematic review and meta-analysis of 11 randomised and comparative studies

Population

Children with obstructive sleep apnoea undergoing adenotonsillectomy with or without a pharyngeal adjunct

Primary outcome

Polysomnographic apnoea-hypopnoea index and surgical success

Effect

No difference in apnoea-hypopnoea index (mean difference 2.22/hour, −4.36 to 8.80) or cure, with comparable bleeding

Adenotonsillectomy is the mainstay for paediatric obstructive sleep apnoea, and some surgeons add pillar suturing or pharyngoplasty hoping to improve the airway result. This meta-analysis of 11 comparative studies tested whether the adjunct helps.

It did not. Postoperative apnoea-hypopnoea index did not differ between tonsillectomy with the adjunct and tonsillectomy alone (mean difference 2.22 events per hour, 95% CI −4.36 to 8.80), and there was no difference in the proportion reaching an apnoea-hypopnoea index below 1, surgical success or quality-of-life scores. Bleeding risk was comparable. Excluding children with Down syndrome did not change the picture.

The practice point is to stop doing the extra step routinely. Adjunctive pharyngeal suturing adds operative time and potential morbidity without a measurable sleep benefit for the typical child, so reserve it, if at all, for an individualised anatomical indication rather than as a default addition to adenotonsillectomy.

• Postoperative apnoea-hypopnoea index did not differ with the adjunct (mean difference 2.22/hour, 95% CI −4.36 to 8.80).
• No difference in reaching apnoea-hypopnoea index <1, surgical success or OSA-18 quality-of-life scores.
• Postoperative bleeding risk was comparable, and excluding Down syndrome did not change the result.
• Do not add routine pharyngoplasty or pillar suturing to adenotonsillectomy for paediatric OSA; individualise if ever.

Why it matters

It removes an extra operative step that costs time and risk without improving the outcome it was meant to.

Don't overread it

Eleven mostly non-randomised studies — this argues against routine use, not that an adjunct could never help a specific anatomical problem.

The statistics, in plain English

The apnoea-hypopnoea index difference straddled zero with a wide interval, meaning no detectable effect; combined with no difference in the stricter cure threshold or quality of life, this is a consistently negative result rather than an underpowered one.

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