Significantly Reducing Post-Tonsillectomy Haemorrhage Requiring Surgery by Suturing the Faucial Pillars: A Retrospective Analysis

Abstract

BackgroundThe tonsillectomy is one of the most frequently performed surgical procedures. Given the comparatively frequent postsurgical bleeding associated with this procedure, particular attention has been paid to reduction of the postoperative bleeding rate. In 2006, we introduced routine suturing of the faucial pillars at our clinic to reduce postoperative haemorrhage.MethodsTwo groups from the years 2003–2005 (n = 1000) and 2007–2009 (n = 1000) have been compared. We included all patients who had an elective tonsillectomy due to a benign, non-acute inflammatory tonsil illness. In the years 2007–2009, we additionally sutured the faucial pillars after completing haemostasis. For primary haemostasis we used suture ligation and bipolar diathermy.ResultsThe rate of bleeding requiring second surgery for haemostasis was 3.6% in 2003–2005 but only 2.0% in 2007–2009 (absolute risk reduction 1.6% (95% CI 0.22%–2.45%, p = 0.04)). The median surgery time—including adenoidectomy and paracentesis surgery—increased from 25 to 31 minutes (p<0.01).ConclusionsWe have been able to substantiate that suturing of the faucial pillars nearly halves the rate of postoperative haemorrhage. Surgery takes 8 minutes longer on average. Bleeding occurs later, mostly after 24 h. The limitations of this study relate to its retrospective character and all the potential biases related to observational studies.

Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study

“…21,34 Primary PTH usually occurs within the first 6 to 8 hrs which constitutes over 80% of primary PTH and is more dangerous due to the risk of aspiration, laryngospasm and low amount continuous bleeding/swallowing, usually not immediately evident as patients are yet to recover fully from GA, with a subsequent circulatory collapse. [35][36][37] Furthermore, much of the mortality in tonsillectomy is directly/indirectly associated with primary PTH Windfuhr et al in a metaanalysis cited several lethal outcomes including a case of fatal hemorrhage from adenoidectomy in a 5-year old female in an attempt to remove adenoidal remnant secondary to a suspected nasopharyngeal arterial anomaly or over curettage despite 10 units of blood transfusion. 18,38 Another meta-analysis reported 71 published court verdicts after adeno-tonsillectomy with over 60% from PTH and its consequences.…”

Incidence and Potential Risk Factors of Post - Tonsillectomy Hemorrhage

“…Windfuhr noted that primary PTH is significantly more common among adults than children. Senska et al added that early onset of bleeding is a consequence of poor quality surgery and more hazardous than secondary bleeding 3,14 .…”

“…Considering that it is an elective procedure, it is often connected with a comparatively high bleeding rate. Furthermore, bleeding in this location (the upper airways) always represents a significant risk 3 .…”

Tonsillitis and sore throat in children

“…with fibrin glue [ 197 ] or sucralfate [ 186 ]) produces no advantage in postoperative bleeding or in pain management. The suturing of the palatal arch is controversial and is obviously dependent on the expertise of the surgeon [ 143 ], [ 199 ].…”