Post-tonsillectomy hemorrhage in children: a single surgeon’s experience with coblation compared to diathermy

Abstract

The aim of this study was to compare coblation and diathermy techniques with respect to secondary post-tonsillectomy hemorrhage (PTH). A total of 1,397 children underwent tonsillectomies with or without adenoidectomy by a single surgeon in a single center from June 2005 through December 2011. A diathermy tonsillectomy was performed on 315 patients for the first 2 years, while a coblation tonsillectomy was performed on 1,082 for the next 5 years. All patients were followed-up within 28 days of surgery by the same surgeon. The characteristics of primary and secondary PTH were analyzed with a retrospective chart review. Primary PTH did not occur in both surgical technique groups. Secondary PTH occurred in 9 patients (2.9 %) in the diathermy group and in 30 patients (2.8 %) in the coblation group. The secondary PTH rates were 1.2, 2.5, 3.8, 3.1 and 4.5 % in the first, second, third, fourth and fifth years after employment of the coblation tonsillectomy, respectively (P = 0.243). Sex, age, tonsil size and severity of tonsillar embedding were not significant factors for PTH. The coblation technique was associated more with late secondary PTH than diathermy technique (odds ratio 9.14, P = 0.049). Analysis of the time of onset of PTH showed that secondary PTH occurred most commonly between 6 p.m. and 6 a.m. In summary, coblation technique has similar secondary PTH rate with diathermy technique although it has increased late secondary PTH rate in children. Coblation technique can be a good alternative to the diathermy technique.

The utility of common surgical instruments for pediatric adenotonsillectomy

“…Postoperative adenotonsillectomy hemorrhage is a feared complication and has a reported occurrence ranging from 2.7% to 15.9% . Postoperative hemorrhage has also been examined in many studies comparing monopolar cautery and radiofrequency ablation, but few to none have included PlasmaBlade analysis . Hong and colleagues compared monopolar cautery to radiofrequency ablation regarding primary and secondary hemorrhage rates and reported no significant difference .…”

“…17 Postoperative hemorrhage has also been examined in many studies comparing monopolar cautery and radiofrequency ablation, but few to none have included PlasmaBlade analysis. 3,5,7,8,12,15,17,18 Hong and colleagues compared monopolar cautery to radiofrequency ablation regarding primary and secondary hemorrhage rates and reported no significant difference. 5 Another group examined monopolar cautery and Plasma-Knife for adenotonsillectomy and reported no significant difference in intraoperative blood loss.…”

“…Although several studies suggest a decreased need for postoperative analgesia with intracapsular coblation techniques, a recent Cochrane review concluded the evidence supporting decreased postoperative pain with radiofrequency ablation to be inadequate . Other reports examining radiofrequency ablation have cited an increase in postoperative hemorrhage and surgical costs . Moreover, inconsistent studies have been published when examining surgical time and insufficient evidence exists to determine whether radiofrequency ablation is superior, in regard to intraoperative efficiency and speed of recovery, when compared to other methods …”

“…6,7 Other reports examining radiofrequency ablation have cited an increase in postoperative hemorrhage and surgical costs. 8,9 Moreover, inconsistent studies have been published when examining surgical time and insufficient evidence exists to determine whether radiofrequency ablation is superior, in regard to intraoperative efficiency and speed of recovery, when compared to other methods. 6,10 Pulsed-electron avalanche knife (PEAK) Plasma-Blade technology was recently developed and is reported to cause less collateral tissue damage than both radiofrequency ablation and electrocautery by utilizing low thermal temperatures, pulsed radiofrequency, and plasma mediated electroconduction.…”

Evaluation of the Efficacy of 1940-nm Diode Laser in Tonsillectomy: Preliminary Report

“…4 However, the efficacy of ultrasonic devices for tonsillectomy is still debatable, although those devices have been reported to induce fewer complications if the expert surgeon uses such instruments with appropriate caution. 5 Lasers have been widely used for intraoral soft tissue procedures and transoral endolaryngeal operations. They can be used to produce immediate and precise tissue destruction in a bloodless manner, forming an incision or ablation with minimal thermal damage to the surrounding, healthy tissue.…”