Does Surgical Technique Influence Post-Tonsillectomy Haemorrhage? Our Experience

Betancourt, Andreina R.; López, C.; Zerpa, Vanessa Zerpa; Carrasco, Marina; Dalmau, José

doi:10.1016/j.otoeng.2014.09.007

Cited by 14 publications

(15 citation statements)

References 17 publications

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“…Controversy still persists in the world literature regarding the occurrence of significantly increased bleeding rates after hot tonsillectomy methods. Some studies have compared post-operative haemorrhage among electrocautery or coblation tonsillectomy patients versus cold dissection patients, and found significant increase in the first [18,[21][22][23]. However, other studies reported no significant differences [14], and concern was expressed that the number of well designed, large, randomised, controlled trials was insufficient to detect small differences in secondary haemorrhage rates [13].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?

Palacios

Álvarez-Morujo

Martínez

et al. 2017

Indian J Otolaryngol Head Neck Surg

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Tonsillectomy is one of the most common surgical procedures performed worldwide. Several techniques have been developed to reduce morbidity and enhance recovery after tonsillectomy. Our study was designed to compare post-operative pain with three different techniques: cold dissection (CD), monopolar-bipolar dissection (MBD) and coblation dissection (CBD). 103 adults were scheduled for elective tonsillectomy from September 2014 to December 2015, and were randomized to CD, MBD and CBD. Post-operative pain was assessed using visual analogue scale (VAS) and Lattinen Test (LT). We did not find significant differences between the groups in the VAS pain scores ( > 0.05), except for the first day, when CBD tonsillectomy showed a higher pain score ( < 0.05). The differences in LT scores between the three techniques were not statistically significant ( > 0.05). Comparison of analgesic consumption between CD, MBD and CBD did not found any significant differences irrespective of the technique used. When first and second week after surgery were compared, differences in analgesics requirements were statistically significant ( < 0.05). Seventeen cases (16.5%) of secondary haemorrhage were reported, but there were no statistical differences in the rate of postoperative bleeding between the three groups ( > 0.05). We conclude that in our study comparison of the three techniques, CD, MBD and CBD, did not show significant differences in the post-tonsillectomy pain scores and bleeding rate.

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Section: Discussionmentioning

confidence: 99%

Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?

Palacios

Álvarez-Morujo

Martínez

et al. 2017

Indian J Otolaryngol Head Neck Surg

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“…In the context of ENT, bipolar Diathermy is not only used in tonsillectomy, but it is also used to treat epistaxis. This is due to the sealing effect the heat has on the blood vessels to achieve haemostasis 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Tonsillectomy Outcomes for Coblation versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

Alsaif

Alazemi

Kahlar

et al. 2020

Preprint

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Introduction There is no consensus on the most superior tonsillectomy technique in adult patients. Recent trials involving coblation technique have shown promising results. Aim The study aims to compare the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Methods A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a search of electronic information was conducted to identify all Randomised Controlled Trials (RCTs) as well as non-randomised studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Reactionary haemorrhage, delayed haemorrhage and postoperative pain were primary outcome measures. Secondary outcome measures included a return to theatre, administration of analgesia, intraoperative bleeding, diet, the effect on tonsils (degree of healing of tonsillar fossae) and operation time. Fixed effects modelling was used for the analysis. Results Four RCTs and two non-randomised studies were identified enrolling a total of 1824 patients. There were no significant differences between the coblation and bipolar groups in terms of reactionary haemorrhage (Odds Ratio [OR] = 1.81, P = 0.51), delayed haemorrhage (OR = 0.72, P = 0.20) or post-operative pain by day 7 (standardised Mean Difference [MD] = -0.15, P = 0.45). For secondary outcomes, there were no differences noted in terms of intraoperative blood loss, diet and the number of cases returned to theatre. Administration of analgesia was reported to be either insignificant between the two groups or higher in the coblation group Also, the coblation group had longer operation time and greater healing effect on tonsillar tissue. Conclusions Coblation is neither a superior or inferior option when compared to bipolar diathermy used in the current clinical practice for adult patients undergoing tonsillectomy as both techniques have similar haemorrhage rates and post-operative pain whilst also lengthening the operative time in coblation.

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“…6,7 The incidence of PTH, regardless of primary or secondary bleed status, ranges from 0.12% to 18%. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] There are numerous studies investigating causative relationships between PTH and the use of perioperative steroids, non-steroidal anti-inflammatory drugs (NSAIDS), antibiotics and narcotics, as well as the surgical method, indication, and sex. 8,[23][24][25][26] However, the literature lacks adequate studies on the relationship of obesity to PTH.…”

Section: Introductionmentioning

confidence: 99%

“…However, the cited mortality associated with PTH ranges from 16% to 54% in the literature . The incidence of PTH, regardless of primary or secondary bleed status, ranges from 0.12% to 18% …”

Section: Introductionmentioning

confidence: 99%

Is weight a predictive risk factor of postoperative tonsillectomy bleed?

Ordemann

Hartzog

Seals

et al. 2018

Laryngoscope Investig Oto

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ObjectiveTo determine if a correlation exists between weight‐for‐age percentile and post‐tonsillectomy hemorrhage in the pediatric population.Study DesignRetrospective study.Methods1418 patients under the age of 15 who underwent tonsillectomy with or without adenoidectomy at a tertiary children's hospital between June 2012 and March 2015 were included in this retrospective study. Patient demographic information, operative and postoperative variables, as well as category and day of postoperative tonsillectomy bleed, if one occurred, were recorded. Fisher's exact and ordinal logistic regression analyses were performed on the full cohort.ResultsThe overall post‐tonsillectomy hemorrhage prevalence was found to be 2.2%, with primary and secondary rates of 0.78% and 1.34%, respectively. Weight‐for‐age percentile, sex, indication for or method of tonsillectomy, or postoperative use of NSAIDs, antibiotics or narcotics were not significantly associated with post‐tonsillectomy hemorrhage. There was a significant relationship between postoperative use of dexamethasone and higher rate of Category 3 post‐tonsillectomy hemorrhage (P = .028).ConclusionThe post‐tonsillectomy hemorrhage rate in our study is consistent with that cited in the literature. No correlation was demonstrated between weight‐for‐age percentile and occurrence of post‐tonsillectomy hemorrhage. Postoperative administration of dexamethasone was associated with a significant increased rate of post‐tonsillectomy hemorrhage requiring surgical intervention, a novel finding.Level of Evidence4

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Does Surgical Technique Influence Post-Tonsillectomy Haemorrhage? Our Experience

Cited by 14 publications

References 17 publications

Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?

Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?

Tonsillectomy Outcomes for Coblation versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

Is weight a predictive risk factor of postoperative tonsillectomy bleed?

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