POSTOPERATIVE BLEEDING AFTER MICRODEBRIDER-ASSISTED INTRACAPSULAR TONSILLECTOMY AND EXTRACAPSULAR TONSILLECTOMY. A RETROSPECTIVE COHORT STUDY

POSTOPERATIVE BLEEDING AFTER MICRODEBRIDER-ASSISTED INTRACAPSULAR TONSILLECTOMY AND EXTRACAPSULAR TONSILLECTOMY. A RETROSPECTIVE COHORT STUDY

Panagiotis Saravakos, Savvas Kourtidis, Serena Preyer

Department of Otorhinolaryngology, Head and Neck Surgery, ViDia Christliche Kliniken Karlsruhe, Karlsruhe, Germany

Introduction: Post-tonsillectomy bleeding is one of the most common complications of tonsillectomy. The rate varies with different methods.

Objective: The purpose of the study was to compare the prevalence of postoperative bleeding after total, extracapsular tonsillectomy, and after subtotal, intracapsular, microscope- and microdebrider- assisted tonsillectomy.

Methods: We retrospectively analyzed patients who underwent a tonsillectomy in a period of two years. We compared two surgical methods, extracapsular tonsillectomy and microscope- and microdebrider-assisted intracapsular tonsillectomy.

Results: Five hundred seventy patients were included in the study. Postoperative hemorrhage occurred in 100 patients (17.5%). By the extracapsular tonsillectomy method, postoperative bleeding was noted in 82 patients (19.7%), while by the intracapsular technique in 18 (11.7%) patients. A return-to-theatre to achieve hemostasis was required in 38 patients (9.1%) and 3 patients (1.9%), respectively.

Conclusion: Our study showed a statistically significant lower incidence of post-tonsillectomy bleeding and need to perform revision surgery under general anesthesia to control bleeding after intracapsular tonsillectomy.

Keywords: Tonsillectomy; Hemorrhage; Bleeding; Microdebrider; Intracapsular; Extracapsular

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How to cite this article:
Panagiotis Saravakos, Savvas Kourtidis, Serena Preyer.Postoperative bleeding after microdebrider-assisted intracapsular tonsillectomy and extracapsular tonsillectomy. A retrospective cohort study.International Research Journal of Otolaryngology, 2022, 5:11. DOI: 10.28933/irjo-2021-12-2105

References:

1. Windfuhr JP, Chen YS. Do changing trends in tonsil surgery affect hemorrhage rates? A longitudinal study covering 1,452,637 procedures. Eur Arch Otorhinolaryngol. 2019;276(9):2585-2593.
2. Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R. Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Otorhinolaryngol. 2016;273(4):989-1009.
3. Koltai PJ, Solares CA, Mascha EJ, Xu M. Intracapsular partial tonsillectomy for tonsillar hypertrophy in children. Laryngoscope. 2002;112(8 Pt 2 Suppl 100):17-19.
4. Wilson YL, Merer DM, Moscatello AL. Comparison of three common tonsillectomy techniques: a prospective randomized, double-blinded clinical study. Laryngoscope. 2009;119(1):162-170.
5. Lee HS, Yoon HY, Jin HJ, Hwang SH. The safety and efficacy of powered intracapsular tonsillectomy in children: A meta-analysis. Laryngoscope. 2018;128(3):732-744.
6. Windfuhr J, Seehafer M. Classification of haemorrhage following tonsillectomy. J Laryngol Otol. 2001;115(6):457-461.
7. Hessén Söderman AC, Ericsson E, Hemlin C, et al. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope. 2011;121(11):2322-2326.
8. Kim JS, Kwon SH, Lee EJ, Yoon YJ. Can Intracapsular Tonsillectomy Be an Alternative to Classical Tonsillectomy? A Meta-analysis. Otolaryngol Head Neck Surg. 2017;157(2):178-189.
9. Tunkel DE, Hotchkiss KS, Carson KA, Sterni LM. Efficacy of powered intracapsular tonsillectomy and adenoidectomy. Laryngoscope. 2008;118(7):1295-1302.
10. Sorin A, Bent JP, April MM, Ward RF. Complications of microdebrider-assisted powered intracapsular tonsillectomy and adenoidectomy. Laryngoscope. 2004;114(2):297-300.
11. Schmidt R, Herzog A, Cook S, O’Reilly R, Deutsch E, Reilly J. Complications of tonsillectomy: a comparison of techniques. Arch Otolaryngol Head Neck Surg. 2007;133(9):925-928.
12. Vaughan AH, Derkay CS. Microdebrider intracapsular tonsillectomy. ORL J Otorhinolaryngol Relat Spec. 2007;69(6):358-363.
13. Nguyen CV, Parikh SR, Bent JP. Comparison of intraoperative bleeding between microdebrider intracapsular tonsillectomy and electrocautery tonsillectomy. Ann Otol Rhinol Laryngol. 2009;118(10):698-702.
14. Stansifer KJ, Szramowski MG, Barazsu L, Buchinsky FJ. Microdebrider tonsillectomy associated with more intraoperative blood loss than electrocautery. Int J Pediatr Otorhinolaryngol. 2012;76(10):1437-1441.
15. Derkay CS, Darrow DH, Welch C, Sinacori JT. Post-tonsillectomy morbidity and quality of life in pediatric patients with obstructive tonsils and adenoid: microdebrider vs electrocautery. Otolaryngol Head Neck Surg. 2006;134(1):114-120.
16. Bitar MA, Rameh C. Microdebrider-assisted partial tonsillectomy: short- and long-term outcomes. Eur Arch Otorhinolaryngol. 2008;265(4):459-463.
17. Baik G, Brietzke SE. Comparison of Pediatric Intracapsular Tonsillectomy and Extracapsular Tonsillectomy: A Cost and Utility Decision Analysis. Otolaryngol Head Neck Surg. 2018;158(6):1113-1118.
18. Amin N, Lakhani R. Intracapsular versus extracapsular dissection tonsillectomy for adults: A systematic review. Laryngoscope. 2019.
19. Bender B, Blassnigg EC, Bechthold J, et al. Microdebrider-assisted intracapsular tonsillectomy in adults with chronic or recurrent tonsillitis. Laryngoscope. 2015;125(10):2284-2290.
20. Johnston DR, Gaslin M, Boon M, Pribitkin E, Rosen D. Postoperative complications of powered intracapsular tonsillectomy and monopolar electrocautery tonsillectomy in teens versus adults. Ann Otol Rhinol Laryngol. 2010;119(7):485-489.