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PubMedDate not supplied

Frequency of post-tonsillectomy haemorrhage following tonsillectomy with bipolar diathermy--an experience at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Tonsillectomy remains one of the most common surgical procedures performed in the world. Various techniques have evolved over the years. One of the most significant complications is postoperative hemorrhage. There is a general perception of increased frequency of PTH with the clectro-cautery technique. A prospective study was designed to determine the frequency of post-tonsillectomy haemorrhage (PTH) following tonsillectomy with bipolar diathermy at ENT department. Ayub Medical College & Teaching Hospital, Abbottabad. METHOD: 246 patients of varying ages and both sexes were operated by the same consultant using bipolar diathermy, during the period of April'2001 to March'2003. All the patients had antibiotic prophylaxis and analgesia on regular basis. Patients were hospitalized for 24-48 hours and were reviewed after one week. RESULTS: 9 (3.6%) patients presented with PTH. These presented between day 3 and 11.4(1.6%) presented with active bleeding, 3(1.2%) presented with clot in the tonsillar fossa and 2(0.8%) had a history of bleeding per-orally at home but did not have evidence of bleeding on arrival. All the patients were hospitalized and treated with a broad spectrum intravenous antibiotic, parenteral analgesia and intravenous fluids. None of the patients needed surgical intervention. CONCLUSION: Tonsillectomy with bipolar diathermy doesn't carry risk of PTH different from other standard techniques. It has the added benefit of minimal per-operative bleeding which bears significance in paediatric population. However adequate training in its use is mandatory to avoid thermal damage to the tissues.

Academic Medical Centers↗
PubMed2005

Comparison of pain after radiofrequency tonsillectomy compared with conventional tonsillectomy: a pilot study.

Tonsillectomy results in a severe sore throat, especially in the first few days, until the exposed and inflamed muscle becomes covered with regenerated mucosa. There are a variety of techniques of tonsillectomy including monopolar and bipolar diathermy, blunt dissection, and most recently radiofrequency tonsil ablation and coblation. The objective of the present study was to assess the postoperative pharyngeal or ear pain of radiofrequency tonsillectomy and compared with traditional blunt dissection tonsillectomy with loop ligation hemostasis.

Adolescent↗
PubMed2004

Long-term effects of intracapsular partial tonsillectomy (tonsillotomy) compared with full tonsillectomy.

OBJECTIVE: To compare the long-term effects (six years after surgery) of two techniques for pediatric tonsil surgery with respect to snoring, apneas, eating difficulties, infections and general health. The two methods were intracapsular partial tonsillectomy (tonsillotomy, "TT") using CO(2)-laser technique and traditional (total) blunt dissection tonsillectomy (TE). STUDY DESIGN: A questionnaire distributed by mail to the parents of children, who, in 1998, were included in a prospective clinical randomized study in one tertiary care ENT clinic. METHOD: A 10 question survey follow-up of 41 children, between 9 and 15 years of age, who originally, six years earlier had been randomized to either TT with CO(2)-laser (n=21) or TE (n=20). The main indication for the surgery was a history of sleep related breathing distress (SRBD). Before the present study, all of the children had participated in earlier follow-ups at six months and one year after surgery. RESULTS: All the children in both groups answered the questionnaire. There were no significant differences between the answers from the two groups in any respects: the effect on snoring and apneas was equally stable for both groups. The number of children who remained free from snoring decreased from 40 after the first year to 25 after six years (11 TT, 14 TE). Snoring in the recurrent cases was not rated to be as frequent or as loud as before the surgery. Infections of the upper respiratory tract (URI) that had been treated with antibiotics occurred to the same extent in both groups. None had eating difficulties. The patients' satisfaction with the results of the surgery was high or very high in 18/21 TT and 20 TE cases, and the vast majority of the parents rated their children's present health status as improved compared with the preoperative condition. CONCLUSION: Tonsillotomy with CO(2)-laser seems to be a reliable method for tonsil surgery with substantially less primary morbidity than conventional tonsillectomy and with the same positive long-term effects after six years.

Child↗
PubMed2006

How we do it: coblation tonsillectomy complication rates from a single ENT department compared with the National Prospective Tonsillectomy Audit.

Coblation tonsillectomy is a relatively new technique, the results of which need auditing within practising units, to justify its continued usage. * The National Prospective Tonsillectomy Audit provides an excellent source of data for individual units to compare their results to. * This retrospective audit of 391 coblation tonsillectomies shows that our units haemorrhage and return to theatre rates are similar to the National rates for cold steel & ties data. * Resolution of training issues and patient selection may lead to increased use of this technique.

Adolescent↗
PubMed1994

Quinsy tonsillectomy or interval tonsillectomy--a prospective randomised trial.

Fifty-one patients with peritonsillar abscesses were randomised to undergo either quinsy tonsillectomy (QT) or interval tonsillectomy (IT), and the two groups were compared. The QT group lost fewer (10.3 v. 17.9) working days and less blood during the operation (158.6 ml v. 205.7 ml); haemostasis was easier and the operation was technically simpler in this group. There was no significant difference in length of hospital stay and neither group had intra- or postoperative complications. Only 64% of the IT group returned for tonsillectomy. In this study QT had distinct advantages over drainage and IT in the management of peritonsillar abscesses.

Absenteeism↗
PubMed2000

Methods of haemostasis in tonsillectomy assessed by pain scores and consultation rates. The Roskilde County Tonsillectomy Study.

OBJECTIVES: To compare four methods of haemostasis after tonsillectomy assessed by pain scores and consultation rates. STUDY DESIGN AND METHODS: A prospective study. The method of sole compression of the tonsillar fossae with gauze tampons was compared to ligation, bipolar diathermy and ligation/diathermy in combination. RESULTS: Highly significantly lower pain scores after discharge were found in the compression group compared to the other three groups (p < 0.025). The consultation rate in person after discharge of the compression group was significantly lower than in the diathermy group (p < 0.01) and the ligation/diathermy group (p < 0.05). CONCLUSION: Sole compression was associated with considerably less morbidity and no higher risk of postoperative haemorrhage. Sole compression should therefore be preferred in tonsillectomy whenever the surgeon considers it to be justified.

Adolescent↗
PubMed2005

Rates and risk factors for subsequent tonsillectomy after prior adenoidectomy: a regression analysis.

OBJECTIVE: To determine the role of adenoidectomy without concurrent tonsillectomy in the treatment of upper airway obstruction, by determining rates and risk factors for subsequent tonsillectomy. DESIGN: Retrospective cohort study with nested case-control study. Data were evaluated using Kaplan-Meyer curves with Cox proportional hazards regression analysis, as well as contingency table and logistic regression analysis. SETTING: Tertiary care pediatric hospital with satellite clinics and surgical centers. PATIENTS: A total of 2462 patients aged 5 months to 18 years undergoing adenoidectomy without concurrent tonsillectomy. MAIN OUTCOME MEASURES: A 5-year database was searched for birth dates, dates of initial surgery, and dates of subsequent tonsillectomy (if performed) or latest follow-up. Cases (tonsillectomies) were then matched 1:1 by age with controls (no subsequent tonsillectomy). Medical charts were reviewed to identify potential predisposing factors, including sex, tonsil size, and adenoidectomy or tonsillectomy indication. RESULTS: Within 5.4 years, 108 patients underwent subsequent tonsillectomy. The relative risk of subsequent tonsillectomy decreases by 0.83 (95% confidence interval, 0.78-0.88) for each increasing year of age at adenoidectomy. The odds of undergoing a future tonsillectomy significantly increase with increasing tonsil size at the time of adenoidectomy. There was a trend toward doubling the risk of subsequent tonsillectomy when the adenoids were removed for upper airway obstruction (including obstructive sleep apnea) compared with other indications (P = .06). CONCLUSION: Knowledge of the rates and risk factors for subsequent tonsillectomy will allow more informed counseling of parents regarding whether tonsillectomy should be performed or deferred at the time of an indicated adenoidectomy.

Adenoidectomy↗
PubMed1979

Abscess tonsillectomy à tiède.

During recent years, primary tonsillectomy, tonsillectomy à chaud, has again become popular as the standard therapy for the peritonsillar abscess, whereas the traditional tonsillectomy à froid, made 4--6 weeks after the incision, has been partially eclipsed. It seems, however, that the intermediate form between these two, tonsillectomy à tiède, an abscess tonsillectomy made 3--4 days after the incision, would be highly practical in many cases, compared with the other two mentioned above. The tonsillectomy à chaud requires such a high state of readiness for anaesthesia, even during the emergency hours, that it is not practical in all otolaryngological departments. Tonsillectomy à tiède needs a longer hospitalization, yet requires fewer days off work than does the classical tonsillectomy à froid method. Furthermore, a significant proportion of the patients fail to present themselves for tonsillectomy at the agreed time and consequently get a recurrence of the disease later on. Tonsillectomy à tiède is almost as easy an operation as the normal tonsillectomy, both for the surgeon as for the patient. During the years 1976--77, 153 cases of peritonsillar abscess were seen. 105 cases were treated with the tonsillectomy à tiède method. The average duration of treatment was 6 1/2 days. The only complications were 6 cases of light secondary bleeding. A tonsillectomy à chaud was performed on 9 children in the age group 3--9 years.

Adolescent↗
PubMed2006

Tonsillectomy as a day-case surgery: a safe procedure?

UNLABELLED: PROBLEM/OBJECTIVES: To assess the safety of tonsillectomy as a one-day procedure, we retrospectively evaluated complications of tonsillectomy within two weeks after surgery. METHODOLOGY: The study included 1977 patients; 85% of the tonsillectomies were performed as a one-day procedure. Tonsillectomies were performed in Ziekenhuis Oost Limburg by one staff ENT and seven ENT residents between January 1, 1996 and January 1, 2005. We also reviewed the number of tonsillectomies performed as day surgery and their complication rate for Belgium, based on the National Office for Health and Disability Insurance billing, comparing our series with the number of tonsillectomies as day-case surgeries and their complication rate for Belgium. RESULTS: In our study, 26 patients (1.3%) consulted within two weeks of surgery for major or minor complications secondary to tonsillectomy. The only major complication was primary bleeding (bleeding within 24 hours after tonsillectomy), which occurred in five patients, all of whom received a revision for haemostasis. No patient required transfusion. Minor complications (21 patients) were secondary bleeding, fever, and anorexia. During the study period, there were 214,524 tonsillectomies performed in Belgium. Based on invoice information, 4676 cases of postoperative bleeding occurred, requiring a revision for haemostasis. In our centre and generally for Belgium, there was an increase in tonsillectomies as an outpatient procedure without an increase in incidence of subsequent bleeding. Day-case surgery tonsillectomy incidence had risen from 36% in 1996 to 64% in 2004 in Belgium. CONCLUSION: Considering the low bleeding and complication rates, tonsillectomy can safely be performed as a day-case surgery.

Adolescent↗