Intracapsular Versus Extracapsular Tonsillectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Tonsillectomy is a common procedure associated with significant postoperative morbidity. Intracapsular tonsil surgery (ICTS), which preserves the tonsillar capsule, may reduce complications compared to traditional extracapsular tonsil surgery (ECTS). This systematic review and meta-analysis evaluates comparative outcomes of ICTS and ECTS, focusing on adult and mixed-age populations. We conducted a systematic review following PRISMA guidelines, searching multiple databases for randomized controlled trials (RCTs) comparing ICTS and ECTS in adult and mixed-age populations (mean age ≥18 years). Primary outcomes were postoperative pain and hemorrhage; secondary outcomes included analgesia use and recovery. Data were pooled using meta-analysis where appropriate. Four RCTs (n=231) were included. ICTS was associated with significantly lower postoperative pain scores and reduced analgesia requirements. The pooled risk of postoperative hemorrhage was significantly lower with ICTS (Risk Ratio 0.34, 95% CI 0.15-0.78, p=0.01). Recovery to normal diet and activity was faster following ICTS. The primary trade-off was a higher incidence of tonsillar remnants, though long-term symptom control remained effective. ICTS may reduce postoperative pain, analgesic use, and hemorrhage risk compared with ECTS, though evidence is limited by small sample sizes, mixed-age populations, and heterogeneous techniques, warranting further adult-specific RCTs.