Histological analysis of tonsillectomies: relationship with surgical technique, post-operative pain and haemorrhage

Magdalena, ML; Solé, Antonio Gens; Blanco, Víctor María Fernández; Rodrigo, Juan P.

doi:10.1017/s0022215116009312

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…Cold dissection technique causes less tissue damage compared to electrocautery [ 23 ], and convincing evidence suggests that TE performed with cold dissection techniques is superior to hot techniques in terms of postoperative late bleeding and pain [ 24 – 31 ]. The large sample size in the present study supports this by demonstrating longer time on analgesics and higher frequency of contacts with health care services in children operated with hot dissection technique.…”

Section: Discussionmentioning

confidence: 99%

Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016

Alm

Stalfors

Nerfeldt

et al. 2017

Eur Arch Otorhinolaryngol

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The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to <18 years) during 2009–2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.

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Section: Discussionmentioning

confidence: 99%

Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016

Alm

Stalfors

Nerfeldt

et al. 2017

Eur Arch Otorhinolaryngol

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“…10 necessary to determine the optimum surgical technique. Magdalena et al [5] have compared histological findings for tonsils removed by cold or electrocautery dissection and their relationship with post-operative complications. They found that patients in the cold dissection group experienced less pain ( p == 0.001) and fewer secondary haemorrhage episodes.…”

Section: Cold Dissectionmentioning

confidence: 99%

Update review of pain control methods of tonsil surgery

et al. 2020

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“…It is generally accepted that primary PTH is due to inadequate hemostasis and secondary PTH is related to tissue trauma incurred during dissection and hemostasis 1,7,8 . A wide body of literature reports the lowest secondary bleeding rates are associated with purely cold (no diathermy) techniques 8–16 . These are considered the “gold standard.” 17 Unfortunately purely cold techniques lead to higher intraoperative blood loss 6,17 and rates of primary PTH, 11,12,18,19 which is difficult to rationalize especially for a young child 4,6,10,14,20 .…”

Section: Introductionmentioning

confidence: 99%

“…These are considered the “gold standard.” 17 Unfortunately purely cold techniques lead to higher intraoperative blood loss 6,17 and rates of primary PTH, 11,12,18,19 which is difficult to rationalize especially for a young child 4,6,10,14,20 . In contradistinction, techniques utilizing diathermy (hot) components for either dissection or hemostasis have been shown to result in higher rates of secondary PTH 8–11,16,19 …”

Section: Introductionmentioning

confidence: 99%

Very‐Low Energy Monopolar Reduces Post‐Tonsillectomy Hemorrhage Versus Standard Energy Techniques

et al. 2021

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Objectives/Hypothesis To compare rates of post‐tonsillectomy hemorrhage (PTH) between a very‐low energy transfer monopolar technique (VLET) and standard energy techniques. Study Design Retrospective controlled cohort study. Methods All tonsillectomies performed by practice physicians during the period January 1, 2010 to August 31, 2019 were identified. Three groups were created based on surgeon technique utilization: the study group (VLET) and two control groups (exclusive standard energy monopolar [Standard]; exclusive “hot” technique without exclusive monopolar use [Mixed “Hot”]). Each group's PTH occurrences requiring surgical intervention (PTHRSI) were identified and rates compared. Results During the study period 11,348 tonsillectomies were performed (4,427 Standard, 1,374 VLET, 5,547 Mixed “Hot”), and 167 (1.47%) PTHRSI events identified (14 primary (<24 hours), 153 secondary (>24 hours), 12 repeat (>1PTHRSI/patient). Compared to the Standard group secondary and total PTHRSI rates (1.47%, 1.60%), the Mixed “Hot” group experienced similar rates (1.57%, P = .54; 1.68%, P = .64), but the VLET group experienced significantly lower rates (0.15%, P = .0026, adjusted odds ratio [OR] 0.114 [0.028–0.469]; 0.22%, P = .0016, adjusted OR 0.155 [0.048–0.494]). Age was a significant risk factor for both secondary and total PTHRSI (P = .0025, P = .0024, adjusted OR 1.02/year [1.01–1.03]). No significant difference in rate of primary PTHRSI was seen collectively or in any age group. The <12VLET Group experienced 0 episodes of secondary PTHRSI and a total PTHRSI rate of 0.09% in 1060 tonsillectomies. Conclusions Standard energy techniques had an adjusted odds ratio over 8‐fold higher for secondary PTHRSI and over 6‐fold higher for total PTHRSI compared to the minimized energy transfer VLET technique. Level of Evidence 3 Laryngoscope, 131:2505–2511, 2021

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Histological analysis of tonsillectomies: relationship with surgical technique, post-operative pain and haemorrhage

Abstract: Cold dissection produces less tissue damage, which is associated with lower incidence of complications. This study suggests that cold dissection is the technique of choice for tonsillectomy.

Cited by 7 publications

References 11 publications

Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016

Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009–2016

Update review of pain control methods of tonsil surgery

Very‐Low Energy Monopolar Reduces Post‐Tonsillectomy Hemorrhage Versus Standard Energy Techniques

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