Tonsillektomienachblutungen im Zeitraum von 1985 bis 2001 und Erfahrungen bei der Anwendung der Lasertonsillotomie bei Kleinkindern

Günzel, Thomas; Zenev, Emil; Heinze, Nicolai; Schwager, K.

doi:10.1055/s-2004-825810

Cited by 13 publications

(8 citation statements)

References 5 publications

(7 reference statements)

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“…We believe that due to the advantages of lasertonsillotomy reported in our and recent studies [3,10,11,16,20] the former disapproval against this technique should be dissolved. The differentiation between hyperplasia and chronic or recurrent tonsillitis seems to be very important for the indication of this procedure.…”

Section: Discussionmentioning

confidence: 81%

Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: A retrospective review

Unkel

Lehnerdt

Schmitz

et al. 2005

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionmentioning

confidence: 81%

Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: A retrospective review

Unkel

Lehnerdt

Schmitz

et al. 2005

International Journal of Pediatric Otorhinolaryngology

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“…2)). Only few clinics analyze possible causes and rates of PTH, effects of newer surgical instruments or make suggestions for an adequate complication management protocol [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41]. For the first time, the Prospective Multicenter Tonsillectomy Study in Austria stratified bleeding events by a sophisticated classification system [42], [43], [44].…”

Section: Discussionmentioning

confidence: 99%

“…Age restrictions as well as assumed advantages of certain surgical instrument as demanded in various contracts are not scientifically supported [112]. Despite the increasing acceptance of TT to resolve upper airway obstruction (with or without sleep-related breathing disorder) [29], [101], [102], [103], [104], [107], [108], [113], differences in postoperative morbidity in contrast to TE were not evident in other studies. Moreover, patients run at risk to experience tonsillar regrowth after TT [114].…”

Section: Discussionmentioning

confidence: 99%

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

Windfuhr

2013

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 12:Doc08; ISSN 1865-1011

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“…In der Studie von Arnoldner wurden intraoperativ bei einem Teil der 6 400 Patienten aber ebenfalls Umstechungsligaturen vorgenommen, ohne, dass deswegen schwere Blutungen mittels Ligatur der Arteria carotis externa-Äste angegangen werden mussten [ 121 ] . Günzel wiederum berichtete über mehrere Fälle, die derartig versorgt werden mussten, obwohl nicht vornehmlich Umstechungsligaturen zur intraoperativen Blutungsstillung verwandt wurden [ 29 ] . Insgesamt erscheint der vermutete enge Zusammenhang zwischen Umstechungsligatur und Massenblutung nicht zwingend vorzuliegen und an andere Faktoren geknüpft.…”

Section: Intraoperativunclassified

Fehler und Gefahren: Tonsillektomie und andere Standard-Eingriffe

Windfuhr

2013

Laryngo-Rhino-Otol

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Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e., tonsillotomies) are increasingly performed. The aim of this study was to evaluate alleged medical malpractice, technical traps and pitfalls associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN).A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications or medico legal implications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published verdicts in Germany.The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed 9 cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including 2 children (5 and 8 years of age) and 7 adults (aged 20-69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; 4 patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. 3 Conciliation Boards submitted expert opinions concerning cases TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only 3 of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (11; 41%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials based on LN were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2).Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged ...

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Tonsillektomienachblutungen im Zeitraum von 1985 bis 2001 und Erfahrungen bei der Anwendung der Lasertonsillotomie bei Kleinkindern

Abstract: A postoperative stay in hospital is sufficient for 3 days, but should vary individually. On young children with symptomatic hyperplasia of the tonsils a lasertonsillotomy should be performed.

Cited by 13 publications

References 5 publications

Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: A retrospective review

Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: A retrospective review

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

Fehler und Gefahren: Tonsillektomie und andere Standard-Eingriffe

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