[Surgically managed postoperative hemorrhage after tonsillectomy]

Bleeding after tonsillectomy is the most frequent and most dangerous complication. We compared the incidence of postoperative bleeding and secondary haemorrhage after tonsillectomy was examined using two methods of hemostasis (suture ligation versus electrocautery).

The study covered all tonsillectomies performed from 1992 to 1994. Data from about 2096 patients were assessed.

The incidence of postoperative bleeding and hemorrhage was 5.4%. When suture ligation of vessels was used to obtain hemostasis during the operation it was evident that postoperative bleeding was rare but more difficult in comparison to the cases in which electrocautery was used alone. While primary bleeding for both methods was similar, secondary bleeding was more frequent after hemostasis achieved with electrocautery.

Injury of the vessel by suture ligation is thought to be responsible for massive hemorrhage after tonsillectomy. Using electrocautery avoids this pathogenic mechanism. Since electrocautery of the tissue surrounding a vessel produces initial hemostasis, secondary bleeding is more frequent after the wound clot is opened.

Use of electrocautery for hemostasis is justified since bleeding after primary hemostasis is usually easily managed.