Full text article. Also available at https://doi.org/10.2147/OAS.S249844We aimed to describe indications and postoperative outcomes of adenotonsillectomy among pediatric patients at a private hospital that serves the largest number of patients with otorhinolaryngological complaints seeking treatment in private health facilities in Tanzania’s largest city. Adenotonsillectomy is one of the commonest surgical procedures in otorhinolaryngology, and indications reported, though scarce in the literature, are infections and sleep-disordered breathing (SDB). Some studies in the last few decades have documented SDB superseding infection. There have been no studies in Tanzania documenting indications and postoperative outcomes of adenotonsillectomy, despite this being a commonly performed surgical procedure. A hospital-based descriptive cross-sectional study was conducted from January to December 2018, where children aged 0– 18 years who had undergone adenotonsillectomy at a private hospital were recruited. Data were analyzed using SPSS version 21. A total of 350 patients aged 0– 18 years were recruited: 60% were children aged < 5 years, 35% 6– 11 years, and 5% 12– 17 years. SDB accounted for a total of 247 (70.5%) indications, while infection accounted for only 60 (17.1%), and when both indications were combined, it accounted for 43 (12.4%) cases. SDB as an indication was proportionally higher in younger children, while infection was higher in older children. Postoperative hemorrhage was encountered in five patients (1.4%). Secondary hemorrhage predominated in four cases (80%), whilst one patient (20%) had primary hemorrhage. Sepsis at the surgical site was found to be the cause for all four patients (100%) with secondary hemorrhage, and the patient with primary hemorrhage had isolated thrombocytopenia as the underlying cause of hemorrhage. SDB was the commonest indication for adenotonsillectomy and postoperative complications were rare encounter, with secondary hemorrhage being predominant.