Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study

Abstract

Background Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic) could be assumed to decrease PTH compared to traditional tonsillectomy (TEtrad). Methods In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured. Results 869 patients were included (183 TEmic; 686 TEtrad). PTH requiring RTT was not seen in the TEmic group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TEmic group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TEtrad were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p > 0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p = 0.007). Conclusion Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TEmic group. Benefit for TEmic was observed in high-volume and long experienced surgeons.

Use of feracrylum in tonsillectomy

“…More recently, lasers, coblation, and harmonic scalpel were utilized for tonsillectomy. 3 Tong et al did not report a single case of primary haemorrhage in their study of 90 tonsillectomies. 4 Robb et al concluded that perioperative use of Tranexemic acid reduces primary haemorrhage.…”

“…Fatal postoperative haemorrhage has been reported to a range between 0.2 and 1.0 per 10,000 performed procedures resulting in an average of 0.9 : 10,000. 3 Over the past four decades lot of efforts have been made to minimize the risk of post tonsillectomy haemorrhage in this surgical procedure. Surgical techniques employed to minimse haemorrhage are monopolar and bipolar dissection, CO2 laser, Coblation, and BiClamp.…”

“…On the other hand, a systematic review showed that Post tonsillectomy in children was not affected by the use of either the hot or the cold surgical technique. 3 In this study we intend to evaluate the use of gauze soaked in feracrylum with that of i.v. tranexemic acid.…”