Adjunctive pillar suturing or pharyngoplasty in pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis.

OBJECTIVE: To evaluate whether pillar suturing or pharyngoplasty added to tonsillectomy with or without adenoidectomy provides additional benefit in children with obstructive sleep apnea (OSA). DATA SOURCES: PubMed, Embase, and the Cochrane Library were systematically searched from database inception to October 2025. REVIEW METHODS: Randomized controlled trials and nonrandomized comparative studies comparing tonsillectomy with adjunctive pharyngoplasty or pillar suturing versus tonsillectomy alone in pediatric OSA were included. Primary outcomes were polysomnography-derived parameters, including apnea-hypopnea index (AHI), oxygen desaturation index, respiratory disturbance index, and minimum oxygen saturation. Secondary outcomes included OSA-18 scores, clinical efficacy, and postoperative complications. Pooled analyses were performed using random-effects models. RESULTS: Eleven studies were included. Meta-analysis showed no significant difference in postoperative AHI between groups (mean difference, 2.22 events/hour; 95% CI, -4.36 to 8.80). No significant differences were observed in postoperative AHI <1 event/hour (odds ratio [OR], 0.75; 95% CI, 0.33 to 1.72), surgical success, or OSA-18 scores. Postoperative hemorrhage risk was also comparable (OR, 0.50; 95% CI, 0.13 to 1.89). Sensitivity analyses excluding studies enrolling children with Down syndrome yielded consistent findings. CONCLUSION: Current evidence does not demonstrate a consistent additional benefit of adjunctive pharyngoplasty or pillar suturing in pediatric OSA surgery. These findings do not support routine adjunctive pharyngeal suturing and underscore the importance of individualized surgical decision-making.