Paediatric patient bleeding and pain outcomes following subtotal (tonsillotomy) and total tonsillectomy: a 10‐year consecutive, single surgeon series

Abstract

Background: Subtotal tonsil surgery (tonsillotomy) remains a controversial procedure. We aimed to document bleeding rates and return to normal activity for total versus subtotal tonsil surgery in the paediatric population. Methods: A 10-year cohort of 608 children from a single-surgeon series was analysed. Bleeding events were classified using the Flinders modification of the Stammberger criteria. Return to normal activity was defined as normal diet and return to childcare/school. Results: A total of 8.3% of tonsil procedures and a subtotal of 1.8% of procedures had some kind of bleeding episode (P < 0.01; odds ratio 3.2; 95% confidence interval (CI) 1.3-7.6). When bloodstained sputum (type A bleed) was excluded, this dropped to 2.5% versus 0.3%, respectively (P < 0.05; odds ratio 8.5; 95% CI 1.2-96.0). Return to normal activities occurred at a mean of 11.1 (95% CI 9.7-12.5) versus 4.6 (95% CI 4.0-5.3) days, respectively (P < 0.0001). Conclusion: In this 10-year single surgeon series, subtotal tonsillectomy or 'tonsillotomy' was associated with a significant reduction in both prevalence and severity of bleeding, in addition to a more rapid return to normal activities when compared to total tonsillectomy.

Coblation intracapsular tonsillectomy in children: A prospective study of 1257 consecutive cases with long‐term follow‐up

“…23 Another recent large cohort study (n = 608) noted similar overall revision surgery rates (2.4%), although it is worth noting that patients with recurrent tonsillitis were largely excluded from the ICT group initially. 24 This further demonstrates that those undergoing ICT for recurrent tonsillitis do not appear to have an additional risk of revision surgery.…”

Intracapsular tonsillectomy versus extracapsular tonsillectomy: a safety comparison

“…Attard and Carney, in their study of 608 paediatric patients, reported an 8.3 and 1.8 per cent post-operative haemorrhage rate for extracapsular tonsillectomy and intracapsular tonsillectomy, respectively. 23 Using a modification of Stammberger's grading system, they also evaluated degrees of bleeding and found, in addition to higher rates, a significantly greater severity of bleeds in the extracapsular tonsillectomy group compared with the intracapsular tonsillectomy cohort. 23 Similarly, Duarte et al found that 88.2 per cent of all postoperative haemorrhage occurred in their extracapsular tonsillectomy group compared with only 11.8 per cent who had undergone intracapsular tonsillectomy.…”

“…23 Using a modification of Stammberger's grading system, they also evaluated degrees of bleeding and found, in addition to higher rates, a significantly greater severity of bleeds in the extracapsular tonsillectomy group compared with the intracapsular tonsillectomy cohort. 23 Similarly, Duarte et al found that 88.2 per cent of all postoperative haemorrhage occurred in their extracapsular tonsillectomy group compared with only 11.8 per cent who had undergone intracapsular tonsillectomy. 24 The systematic review by Zhang et al demonstrated a 79 per cent reduction in secondary haemorrhage occurring in intracapsular tonsillectomy vs extracapsular tonsillectomy.…”

“…19 As a result of the disparity, published revision rates range between 0.7 per cent to 11.9 per cent. 11,18,23,30,31 Meta-analyses by Kim et al and Gorman et al as well as the systematic review by Walton et al found no difference in the recurrence of obstructive symptoms between intracapsular tonsillectomy and extracapsular tonsillectomy groups. 5,14,32 Postoperative recurrent tonsillitis and pharyngitis were also not found to be any greater when using intracapsular tonsillectomy.…”

Subtotal intracapsular tonsillectomy may be the first choice for tonsillectomy in children

“…A literature review revealed that the recurrence rate after tonsillotomy was approximately 3%, younger children had a higher risk of recurrence, and the most common cause of reoperation was snoring. 16 , 17 , 19 Waldeyer’s ring is composed of numerous lymphoid follicles in the lamina propria of the pharyngeal mucosa, which integrates into adenoid lymphoid tissue and forms a ring. The lymphoid tissue in Waldeyer’s ring restricts the growth of tissue in both areas, so we often find after tonsillectomy combined with adenoidectomy that the cause of nasal obstruction and snoring is tonsillar hypertrophy of the eustachian tube.…”