Bipolar diathermy versus cold dissection in paediatric tonsillectomy

Hesham, Ahmed

doi:10.1016/j.ijporl.2008.09.026

Cited by 20 publications

(20 citation statements)

References 19 publications

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“…PTH may have been reported as primary (generally defined as occurring within 24 hours of surgery), secondary (generally defined as occurring more than 24 hours postoperatively), or at an undefined or unspecified time. 8–108 Seventy-three studies contributed data to the meta-analysis (66 RCTs, 19,20,23,25,27,29,33,34,36,38–41,43,44,46,47,49,50,52–59,62–64,67,71,72,74–79,81–84,88–92,95,101–105,108–122 6 nonrandomized trials, 24,35,37,45,48,94 and 1 prospective cohort study 70 ). The resulting subset of studies included the following tonsillectomy techniques: cold dissection, electrocautery, coblation, harmonic scalpel, laser, molecular resonance, thermal welding, and microdebrider.…”

Section: Resultsmentioning

confidence: 99%

“…8–15,19,20,23,25,27,33–41,43–47,50–59,62–64,67,70–79,81–84,88,89,91,92,94–98,101,102,106–108,177 The 6299 children across studies who were treated with total tonsillectomy experienced 265 episodes (4.2%) of PTH (Table 2). PTH ranged from parent-reported bleeding that did not require accessing clinical care to reoperation for hemostasis.…”

Section: Resultsmentioning

confidence: 99%

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Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Francis

Fonnesbeck

Sathe

et al. 2017

Otolaryngol.--head neck surg.

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Objective To assess post-tonsillectomy hemorrhage (PTH), associated non-operative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and also conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was below 4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also below 5% overall (4.2% for total tonsillectomy; 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH occurred with tonsillectomy for obstructive sleep-disordered breathing than throat infection. In meta-analysis, frequency of PTH-associated non-operative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least four deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Though studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus we cannot conclude that a given technique is superior.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Francis

Fonnesbeck

Sathe

et al. 2017

Otolaryngol.--head neck surg.

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“…A wide range of techniques such as blunt dissection, guillotine, bipolar or monopolar diathermy, laser, harmonic scalpel, microdebrider, or coblation, is used to perform total or partial tonsillectomy [1][2][3][4]. Despite the availability of different techniques, tonsillectomy is still associated with a risk of postoperative bleeding ranging from 0.28 to 20% [5][6][7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels

Ulualp

2011

Eur Arch Otorhinolaryngol

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The objective of this paper is to describe an extended microscopic hemostasis technique involving cauterization of exposed blood vessels that were not actively bleeding in tonsillar fossa after bipolar tonsillectomy and to assess the rate of post-tonsillectomy hemorrhage with this technique in children who had bipolar tonsillectomy. The medical records of children who underwent microscopic bipolar tonsillectomy with extended hemostasis between June 2008 and January 2011 were reviewed. Relevant history and physical examination, diagnosis, and characteristics of postoperative hemorrhage were recorded; 994 children (531 males, 463 females), aged between 1 and 18 years (6 ± 3 years), underwent tonsillectomy; of the 994 patients, 11 (1.1%) developed post-tonsillectomy hemorrhage. No primary post-tonsillectomy hemorrhage occurred. The hemorrhage was seen 6-13 days after the surgery. One patient had bleeding after having trauma to the neck on postoperative day 13. Of the 11 patients with post-tonsillectomy bleeding, 3 had blood clot with no active bleeding and 8 exhibited active bleeding after removal of blood clot. Of the 994 patients, 8 (0.8%) needed intervention to control active bleeding. Compared to previous studies of bipolar tonsillectomy, extended microscopic hemostasis achieved by cauterization of tonsil fossa non-bleeding blood vessels appeared to reduce bleeding rate after bipolar cautery tonsillectomy. The present study did not include a control arm; further randomized controlled studies are needed to establish the definite effect of extended microscopic hemostasis technique on the rate of hemorrhage rates after tonsillectomy techniques.

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“…However, to our knowledge, the technique has never been described despite its usefulness. Though several studies have discussed the technique of tonsillectomy [1,2], we could not find any reference to this method or anything similar. Among the textbooks of otolaryngology surgery, none has referred to this technique [3,4].…”

Section: Discussionmentioning

confidence: 95%

“…Though there are several techniques of tonsillectomy [1,2] based on surgeons, facilities and countries, they commonly involve the use of one hand to hold one tool and the other to hold another tool. To control bleeding from the operation site, one hand is often used for retraction of the tonsil while the other is used to hold and manipulate an electric cautery device (e.g., bipolar coagulator) and then occasionally switch to forceps with cotton to clear the accumulated blood.…”

Section: Introductionmentioning

confidence: 99%