Predicting early and delayed bleedings in children who undergo adeno‐tonsillectomy surgery. Is it really possible?

Capua, Mirko Di; Burzo, Maria Livia; Palo, Mariagiovanna Di; A, Marino; Lorenzo, Giuseppe Di; Mesolella, Massimo; Mormile, Rosaria; Minno, G. Di; Cerbone, Anna Maria

doi:10.1111/hae.12552

Cited by 3 publications

(3 citation statements)

References 12 publications

(15 reference statements)

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“…Adenotonsillectomy is the first therapeutic choice in paediatric-age patients with an OSAS diagnosis linked to adenotonsillar hypertrophy. This surgery allows an improvement in sleep respiratory disorders, in the grand majority of cases, and remains the gold-standard for paediatric OSAS treatment [ 22 , 24 , 38 , 41 , 42 , 43 , 44 , 45 ]. With the aim of minimising surgical morbidity, with equal functional results, intracapsular tonsillotomy was introduced in our clinical procedure and carried out with the microdebrider [ 4 , 23 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS

Mesolella

Allosso

Coronella

et al. 2023

JPM

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Objective: The objective of our study was to compare our experience of intracapsular tonsillotomy performed with the help of a microdebrider usually used for adenoidectomy with results obtained from extracapsular surgery through dissection and from adenoidectomy in cases of people affected with OSAS, linked to adeno-tonsil hypertrophy, observed and treated in the last 5 years. Methods: 3127 children with adenotonsillar hyperplasia and OSAS-related clinical symptoms (aged between 3 and 12 years) underwent tonsillectomy and/or adenoidectomy. A total of 1069 patients (Group A) underwent intracapsular tonsillotomy, while 2058 patients (Group B) underwent extracapsular tonsillectomy, from January 2014 to June 2018. The parameters considered in order to evaluate the effectiveness of the two different surgery techniques taken into consideration were as follows: the presence of possible postoperative complications, represented mainly by pain and perioperative bleeding; the level of postoperative respiratory obstruction compared with the original obstruction through night pulse oximetry, performed 6 months before and after the surgery; tonsillar hypertrophy relapse in Group A and/or the presence of residues in Group B with clinical evaluation performed 1 month, 6 months, and 1 year after the surgery; and postoperative life quality, evaluated through submitting to parents the same survey proposed before the surgery 1 month, 6 months, and 1 year after the surgery. Results: Regardless of the technique used (extracapsular tonsillectomy or intracapsular tonsillotomy), there was a clear improvement in both the obstructive respiratory symptomatology and quality of life in both patient groups, as highlighted by the pulse oximetry and the OSA-18 survey submitted later. Conclusions: Intracapsular tonsillotomy surgery has improved in terms of a reduction in postoperative bleeding cases and pain reduction, with an earlier return to patients’ usual lifestyle. Lastly, using a microdebrider with the intracapsular technique seems to be particularly effective in removing most of the tonsillar lymphatic tissue, leaving only a thin border of pericapsular lymphoid tissue and preventing lymphoid tissue regrowth during one year of follow-up.

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Section: Discussionmentioning

confidence: 99%

Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS

Mesolella

Allosso

Coronella

et al. 2023

JPM

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“…This change in approach to a bleeding patient would first be validated in a future study in which an algorithm would be implemented, that withholds further haemostatic testing based on several arguments, like a high BAT score on isolated items or the type of surgery or method of delivery. The most notorious interventions at young age that lead to excessive blood loss in case of an underlying haemostatic disorder are tonsillectomies and circumcisions . In case of delivery, the risk of excessive blood loss is increased during a caesarean section compared to a vaginal deliver …”

Section: Discussionmentioning

confidence: 99%

“…This retrospective observational study showed that patients without final diagnosis but a high BAT had a higher BAT score than patients young age that lead to excessive blood loss in case of an underlying haemostatic disorder are tonsillectomies and circumcisions. [19][20][21] In case of delivery, the risk of excessive blood loss is increased during a caesarean section compared to a vaginal deliver. 22 In addition, in our study, men appeared to have a higher chance of achieving final diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic work up of patients with increased bleeding tendency

et al. 2019

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Introduction The diagnostic trajectory of patients with increased bleeding tendency can be very costly and time‐consuming. In addition, previous studies have shown that half of these patients remain without final diagnosis despite all efforts. Aim This study aimed to improve insight into the current diagnostic process of these patients. Methods A total of 117 adult patients, referred to an academic hospital because of being suspected to have an increased bleeding tendency, were included. Different parameters were compared between patients receiving final diagnosis, patients without final diagnosis but a high Tosetto bleeding assessment tool (BAT) score (classified as bleeding of unknown cause, or BUC) and a control group consisting of patients without final diagnosis and a low BAT score. Results The BAT score was significantly higher in patients in the BUC group as compared to patients reaching final diagnosis (8.1 vs 4.9). Interestingly, the two subcategories most prevalently increased were surgery and post‐partum haemorrhage‐associated bleeding (surgery: 2.1 vs 1.1; post‐partum haemorrhage: 0.7 vs 0.0). Laboratory screening results were more often abnormal in patients reaching final diagnosis compared to patients remaining without diagnosis and a high BAT score (n = 32 (78%) vs n = 14 (46%), 95% CI 1.5‐12), especially concerning the PFA (=27 (66%) vs n = 10 (33%), 95% CI 1.4‐10) and von Willebrand factor activity levels (n = 11 (27%) vs n = 1 (3%), 95% CI 1.3‐91). Conclusion Isolated high bleeding score on surgical or post‐partum bleeding correlates with a lower chance of receiving final diagnosis. Withholding extensive haemostatic testing should be considered. Better screening and confirmative haemostatic assays are still needed.

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Intraoperative ketorolac for pediatric tonsillectomy: Effect on post-tonsillectomy hemorrhage and perioperative analgesia

Rabbani¹,

Pflum²,

Ye³

et al. 2020

International Journal of Pediatric Otorhinolaryngology

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Predicting early and delayed bleedings in children who undergo adeno‐tonsillectomy surgery. Is it really possible?

Cited by 3 publications

References 12 publications

Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS

Extracapsular Tonsillectomy versus Intracapsular Tonsillotomy in Paediatric Patients with OSAS

Diagnostic work up of patients with increased bleeding tendency

Intraoperative ketorolac for pediatric tonsillectomy: Effect on post-tonsillectomy hemorrhage and perioperative analgesia

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