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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage
J P Windfuhr1, A Wienke, Y S Chen
1Department of Otorhinolaryngology, Plastic Head and Neck Surgery, St Anna Hospital, Albertus Magnus Str. 33, 47259, Duisburg, Germany. jochen.windfuhr@malteser.de
Summary
Tonsillectomy techniques vary globally, impacting post-tonsillectomy hemorrhage (PTH) risk. This study found secondary bleeding is linked to electrosurgery, with rare fatal outcomes, even after intracapsular tonsillectomy.
Area of Science:
- Otorhinolaryngology
- Surgical Techniques
- Patient Safety
Background:
- Tonsillectomy techniques lack global standardization, potentially influencing post-tonsillectomy hemorrhage (PTH) rates.
- Certain surgical methods are identified as risk factors for PTH.
Purpose of the Study:
- To assess the uniformity of tonsillectomy techniques within a large population.
- To investigate the relationship between surgical techniques, PTH incidence, and lethal outcomes.
Main Methods:
- A questionnaire survey was distributed to 156 otorhinolaryngology departments, assessing tonsil dissection, hemostasis techniques, PTH rates, and outcomes.
- Data from 138 responding departments (88.5% response rate) covering 54,572 tonsillectomies in 2006 were analyzed anonymously.
Main Results:
- Cold dissection was the predominant teaching method; suture ligation or bipolar cautery were common hemostasis techniques.
- Secondary bleeding (occurring >24 hours post-op) was more prevalent (97 responses).
- Secondary PTH showed a statistically significant association with electrosurgery. Fatal outcomes were rare (estimated 1/75,000), occurring even after intracapsular tonsillectomy.
Conclusions:
- Tonsillectomy practices are not uniform, with 'conventional tonsillectomy' encompassing diverse methods.
- Electrosurgery is a significant risk factor for secondary post-tonsillectomy hemorrhage.
- While rare, fatal outcomes are possible following tonsillectomy, irrespective of technique.
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