Effect of Suturation Plus Surgicel Application on Post-Tonsillectomy Bleeding and Pain

Çetiner, Hasan; Cavusoglu, Ilker; Düzer, Sertaç; Sakallıoğlu, Öner; Susaman, Nihat; Yildirim, Yavuz Sultan Selim

doi:10.1097/scs.0000000000003827

Cited by 12 publications

(15 citation statements)

References 28 publications

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“…Most of our participants stated that they utilised both of these methods during the procedure. A number of different extra measures to prevent secondary post-tonsillectomy bleeding have been described in the literature, including suturing the faucial pillars together 3 , 10 . However, the benefits of these measures are controversial 11 , 12 .…”

Section: Discussionmentioning

confidence: 99%

Surgeons’ preferences and anxiety levels in paediatric adenotonsillectomy: European perspective

Kılavuz

Bayram²

2019

J. Laryngol. Otol.

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ObjectiveThis study assessed the preferences of surgeons regarding surgical modalities used for adenotonsillectomy, and determined anxiety levels related to the adenotonsillectomy procedure.MethodsA 10-question survey created by the authors was administered to 413 ENT specialists attending the 4th Congress of Otorhinolaryngology Head and Neck Surgery, held in October 2017 in Barcelona, Spain.ResultsCold knife dissection was the preferred surgical modality for both adenoidectomy and tonsillectomy. Most participants reported encountering one to five patients with post-tonsillectomy bleeding throughout their entire career. The mean anxiety levels during surgery and the 10-day post-operative period were 3.39 ± 2.14 and 4.18 ± 2.63, respectively (p < 0.05). There was a significant negative correlation between anxiety level and surgeon's experience (p < 0.05).ConclusionCold dissection is still the preferred surgical modality for adenotonsillectomy, while both suture ligation and electrocautery are used for haemostasis. Paediatric adenotonsillectomy is likely to generate anxiety in ENT surgeons, and the possibility of secondary post-tonsillectomy bleeding increases the anxiety levels of surgeons in the post-operative period.

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Section: Discussionmentioning

confidence: 99%

Surgeons’ preferences and anxiety levels in paediatric adenotonsillectomy: European perspective

Kılavuz

Bayram²

2019

J. Laryngol. Otol.

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“…The study qualities ranged between 4 and 9, that is, overall moderate or high quality (Table 1). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] 3.3 | Primary outcome…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta‐analysis

Wang

et al. 2022

Laryngoscope Investig Oto

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Objective This study was to compare tonsillectomy with intraoperative suturing (TIS) and tonsillectomy without intraoperative suturing (TsIS) in preventing postoperative tonsillectomy hemorrhage (PTH). Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines was followed. Articles compare TIS and TsIS in preventing PTH were included. The quality of eligible studies was assessed with the Newcastle‐Ottawa Scale (NOS) by two independent investigators. Random effect models were used to determine odds ratio (OR) with 95% CIs. Results A total of 15 studies were analyzed. The pooled results showed the PTH rate was lower in the TIS group (OR = 0.64; 95% CI, 0.47–0.88). The TIS group had a lower primary and secondary PTH rate than the TsIS group with OR values of 0.44 (95% CI, 0.30–0.64) and 0.70 (95% CI, 0.54–0.90), respectively. However, suturing did not show an advantage in reducing the risk of returning to the operation room for hemostasis (OR = 0.57; 95% CI, 0.13–2.47). Adults might benefit from the intraoperative suturing procedure (OR = 0.31; 95% CI, 0.16–0.60). Patients with more than three stitches on each side had a lower PTH rate (OR: 0.44; 95% CI, 0.32–0.60). Suturing the tonsillar fossa and pillars simultaneously could reduce the PTH rate (OR = 0.47; 95% CI, 0.34–0.64). Conclusions Intraoperative suturing is a good strategy for preventing PTH. More multicenter randomized controlled studies should be conducted to demonstrate the efficacy of this procedure. Level of Evidence 5.

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“…Not cost efficient. Too expansive for some surgical units [58]Y TachoSil [48]Y Evarrest® [54]N TachoCombGelatin-based HemostatGelatin-Thrombin Hemostatic Matrix (GTHM)Y [67]NY [61], [67]N [68]Case study by reviewing 42 pediatric patients and retrospective data analysis [61], randomized, controlled trial in adults [68, 69] and children [67, 70] and a review [71]Floseal™ Hemostatic MatrixPost-op [61, 71]simple, safe, and efficacious and cost-effective [61, 70]Y [72]Absorbable cellulose-based Hemostatoxidized cellulose polymer hemostatic agentY [73]Y (when combine with suturation) [74]N (when combine with suturation) [74]Surgicel plus saturation on total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years [74]Surgicel®, Cellistypt®, Pahacel®, Oxycel®, Gelita®, GuraTamp®Intra-opaids in clot formation by activation of the extrinsic and intrinsic coagulation pathways,Introduced a risk of aspiration and suffocation [75]; Possible inflammation [76]. Y Surgicel® [77]N for othersBismuth subgallate-basedBSG- adrenaline paste, BSG- phenylephrine hydrochloride mixtureY [78]Y (BSG mixed with phenylephrine hydrochloride) [79]Y BSG with adrenaline for primary PTH [80], N for secondary PTH [81]N [81]Clinical study on patients underwent tonsillectomy [78, 81]Spectrum Chemical (powder), mixing 26 g of BSG powder to 20 ml of normal saline with 0.7 ml of 1:1000 adrenalinePost-opdecreases operating time by significantly reducing the hemostasis time and the number of ligatures [78, 81]; accelerates the cascade of blood clotting [79]; accelerate the intrinsic clotting pathway through the activation of factor XII (Hageman factor) [82].…”

Section: Main Text: Topical Biomaterials Used For Pthmentioning

confidence: 99%

“…A review of topical hemostatic agents in 2010 found that Surgicel had been used in otolaryngologic procedures, such as mastoid and endonasal surgeries [60]. For tonsillectomy, Surgicel application plus suturing decreases PTH rates [74].…”

Section: Main Text: Topical Biomaterials Used For Pthmentioning

confidence: 99%

“…No oxidized cellulose-based biomaterial products demonstrate strong adhesive properties, leading to a risk of aspiration and suffocation [75], as well as a potential risk of inflammation [76]. To reduce the risk in tonsillectomy, cellulose-based biomaterial must be combined with suturing which can prolong operative time and adversely impact outcomes [74].…”

Section: Main Text: Topical Biomaterials Used For Pthmentioning

confidence: 99%

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Topical biomaterials to prevent post-tonsillectomy hemorrhage

Liu

Rodman

Worobetz

et al. 2019

Journal of Otolaryngology - Head & Neck Surgery

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Despite advances in surgical technique, postoperative hemorrhage remains a common cause of mortality and morbidity for patients following tonsillectomy. Application of biomaterials at the time of tonsillectomy can potentially accelerate mucosal wound healing and eliminate the risk of post-tonsillectomy hemorrhage (PTH). To understand the current state and identify possible routes for the development of the ideal biomaterials to prevent PTH, topical biomaterials for eliminating the risk of PTH were reviewed. Alternative topical biomaterials that hold the potential to reduce the risk of PTH were also summarized.

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Effect of Suturation Plus Surgicel Application on Post-Tonsillectomy Bleeding and Pain

Abstract: Suturation plus Surgicel application increased pain levels while decreasing bleeding incidence during the postoperative period.

Cited by 12 publications

References 28 publications

Surgeons’ preferences and anxiety levels in paediatric adenotonsillectomy: European perspective

Surgeons’ preferences and anxiety levels in paediatric adenotonsillectomy: European perspective

Can intraoperative suturing reduce the incidence of posttonsillectomy hemorrhage? A systematic review and meta‐analysis

Topical biomaterials to prevent post-tonsillectomy hemorrhage

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