Efficacy of pillar suture for post-tonsillectomy morbidity in children: a meta-analysis

Kim, Jisun; Kim, Byung Guk; Kim, Dong-Hyun; Hwang, Se Hwan

doi:10.1016/j.bjorl.2019.12.007

Cited by 6 publications

(7 citation statements)

References 28 publications

(32 reference statements)

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“…We did prefer to control bleeding in the operating room more than bedside treatment. It is ideal for surgeons to select the surgical procedure they are most familiar with to prevent bleeding, regardless of whether electrocoagulation or suturing of the tonsil pillars is considered the common measure[ 38 , 39 ]. The incidence rate of postoperative hemorrhage is an important quality and safety indicator in tonsillectomy and should not be ignored [40].…”

Section: Discussionmentioning

confidence: 99%

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy

Xu¹,

Jin

et al. 2021

WJCC

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BACKGROUND Tonsillectomy is the most common procedure for treatment of pediatric recurrent acute tonsillitis and tonsillar enlargement that contributes to obstructive sleep apnea hypopnea syndrome. Postoperative hemorrhage of tonsillectomy is a life-threatening complication. AIM To identify the risk factors that may contribute to primary and secondary post-operative hemorrhage in pediatric tonsillectomy. METHODS The clinical data from 5015 children, 3443 males and 1572 females, aged 1.92-17.08 years, with recurrent tonsillitis and/or tonsil hypertrophy who underwent tonsillectomy in our hospital from January 2009 to December 2018 were retrospectively collected. The variables including sex, age, time of onset, diagnosis, method of tonsillectomy, experience of surgeon, time when the surgery started and monthly average air temperature were abstracted. The patients with postoperative hemorrhage were classiﬁed into two groups, the primary bleeding group and the secondary bleeding group, and their characteristics were compared with those of the nonbleeding group separately. Statistical analysis was performed by chi-square test with SPSS 20. RESULTS Ninety-two patients had post-tonsillectomy hemorrhage, and the incidence rate of post-tonsillectomy hemorrhage was 1.83%. The mean age was 5.75 years. Cases of primary hemorrhage accounted for approximately 33.70% (31/92), and cases of secondary hemorrhage occurred in 66.30% (61/92). The rate of reoperation for bleeding was 0.92%, and the rate of rehospitalization for bleeding was 0.88% in all patients. Multiple hemostasis surgery was performed in 6.52% (3/46) of patients. The method of tonsillectomy (coblation tonsillectomy) and experience of the surgeon (junior surgeon with less than 5 years of experience) were significantly associated with primary hemorrhage ( χ 2 = 5.830, P = 0.016, χ 2 = 6.621, P = 0.010, respectively). Age (over 6 years old) and time of onset (more than a 1-year history) were significantly associated with secondary hemorrhage ( χ 2 = 15.242, P = 0.000, χ 2 =4.293, P = 0.038, respectively). There was no signiﬁcant difference in sex, diagnosis, time when the surgery started or monthly average air temperature. There was a signiﬁcant difference in the intervention measures between the primary bleeding group and the secondary bleeding group ( χ 2 = 10.947, P = 0.001). The lower pole and middle portion were the common bleeding sites, followed by the upper pole and palatoglossal arch. CONCLUSION The incidence rate of post-tonsillectomy hemorrhage is low. Coblation tonsillectomy and less tha...

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Section: Discussionmentioning

confidence: 99%

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy

Xu¹,

Jin

et al. 2021

WJCC

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“…Absorbable sutures might cause a higher wound infection rate due to the greater inflammatory response or tissue reactivity 34,35 . However, a meta‐analysis showed that suturing the pillars did not increase the rate of suture site infection 36 . The majority of the studies in this meta‐analysis preferred absorbable sutures.…”

Section: Discussionmentioning

confidence: 90%

“…34,35 However, a metaanalysis showed that suturing the pillars did not increase the rate of suture site infection. 36 The majority of the studies in this metaanalysis preferred absorbable sutures. We divided the patients into two groups, according to the number of stitches at operation.…”

Section: Discussionmentioning

confidence: 98%

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta‐analysis

Wang

et al. 2022

Laryngoscope Investig Oto

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Objective This study was to compare tonsillectomy with intraoperative suturing (TIS) and tonsillectomy without intraoperative suturing (TsIS) in preventing postoperative tonsillectomy hemorrhage (PTH). Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines was followed. Articles compare TIS and TsIS in preventing PTH were included. The quality of eligible studies was assessed with the Newcastle‐Ottawa Scale (NOS) by two independent investigators. Random effect models were used to determine odds ratio (OR) with 95% CIs. Results A total of 15 studies were analyzed. The pooled results showed the PTH rate was lower in the TIS group (OR = 0.64; 95% CI, 0.47–0.88). The TIS group had a lower primary and secondary PTH rate than the TsIS group with OR values of 0.44 (95% CI, 0.30–0.64) and 0.70 (95% CI, 0.54–0.90), respectively. However, suturing did not show an advantage in reducing the risk of returning to the operation room for hemostasis (OR = 0.57; 95% CI, 0.13–2.47). Adults might benefit from the intraoperative suturing procedure (OR = 0.31; 95% CI, 0.16–0.60). Patients with more than three stitches on each side had a lower PTH rate (OR: 0.44; 95% CI, 0.32–0.60). Suturing the tonsillar fossa and pillars simultaneously could reduce the PTH rate (OR = 0.47; 95% CI, 0.34–0.64). Conclusions Intraoperative suturing is a good strategy for preventing PTH. More multicenter randomized controlled studies should be conducted to demonstrate the efficacy of this procedure. Level of Evidence 5.

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“…The treatment of children's facial emergency trauma usually requires more sophisticated cosmetic suture technology because their families require better prognosis. 18 However, because children patients cannot communicate effectively between doctors and patients, their compliance is poor, and it is difficult to cooperate with cosmetic suture perioperative treatment. 19 For children who use non-absorbable nylon thread to suture, anaesthesia is generally not recommended when removing stitches.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of absorbable collagen thread and cosmetic suture technique in emergency treatment of children's facial trauma

Zhang

Han

Yuan

et al. 2022

J Paediatrics Child Health

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Aim To explore the effect of absorbable collagen thread and cosmetic suture technique on scar inhibition after emergency facial trauma in children, and to explore the application value of absorbable collagen thread in emergency facial trauma. Methods Children who received emergency treatment of facial trauma in plastic surgery department from January 2021 to January 2022 were analysed retrospectively, and were divided into absorbable collagen thread group and non‐absorbable nylon thread group. The general data, scar appearance and local symptoms of the two groups were analysed, and the scar appearance was scored by scar beauty rating scale and non‐inferiority test was analysed statistically. Results A total of 632 children with facial trauma were included in this study, including 458 patients with absorbable collagen thread and 174 patients with non‐absorbable nylon thread. The SCAR score of the absorbable collagen thread group (3.03 ± 1.57) was similar to that of the non‐absorbable nylon thread group (2.98 ± 2.39) (95% confidence interval), and the final scar outcome score was not statistically different (P > 0.05). All families of the patients were satisfied with the results of the procedure, 95% very satisfied. Conclusion The use of absorbable collagen thread and cosmetic suture technique to treat the wounds of children with facial emergency trauma, resulted in good wound healing, little scar expansion, low incidence of erythema and pigment abnormality, no obvious surgical trace, and no scar hypertrophy or atrophy. The overall impression was good, the pain of stitch removal was avoided for children's patients, and the satisfaction of family members was high. Cosmetic suture technique with absorbable sutures is worthy of clinical application.

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Efficacy of pillar suture for post-tonsillectomy morbidity in children: a meta-analysis

Cited by 6 publications

References 28 publications

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta‐analysis

Clinical application of absorbable collagen thread and cosmetic suture technique in emergency treatment of children's facial trauma

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