Introduction: Adenoidectomy is one of the commonest surgical procedures in children. Techniques vary, with different devices (curette, diathermy, plasma ablation, and microdebrider) and approaches (transnasal TN and transoral TO) in widespread use. A systematic review was performed to determine the efficacy, efficiency and outcomes of current techniques and approaches. Methods and analysis: A systematic review following the PRISMA guidelines was conducted. PubMed, EMBASE, The Cochrane Library, Web of Science, CINAHL were used during the literature searches. Quality assessment of included studies was performed using the Newcastle-Ottawa Scale. Results: 3185 studies were identified, 17 were included in the systematic review. 1799 patients underwent adenoidectomy, with a post-operative complication rate of 8.67% patients (n=156). Common complications identified included vomiting 2.33% (n=42); haemorrhage: primary 0.83% (n=15), secondary 0.72% (n=13) and nasal obstruction 1.55% (n=28). The microdebrider had the lowest levels of blood loss (TN 12.26 ml vs TO 12.65 ml; p=0.93) and reduced operating time (TN 6.47 mins vs TO 8.63 mins; p=0.25). Conclusion: Adenoidectomy remains a safe procedure with few post-operative complications. The microdebrider has some advantages over other techniques.