Skip to main content

Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels

European Archives of Oto-Rhino-Laryngology volume 269, pages 1269–1275 (2012)Cite this article

Abstract

The objective of this paper is to describe an extended microscopic hemostasis technique involving cauterization of exposed blood vessels that were not actively bleeding in tonsillar fossa after bipolar tonsillectomy and to assess the rate of post-tonsillectomy hemorrhage with this technique in children who had bipolar tonsillectomy. The medical records of children who underwent microscopic bipolar tonsillectomy with extended hemostasis between June 2008 and January 2011 were reviewed. Relevant history and physical examination, diagnosis, and characteristics of postoperative hemorrhage were recorded; 994 children (531 males, 463 females), aged between 1 and 18 years (6 ± 3 years), underwent tonsillectomy; of the 994 patients, 11 (1.1%) developed post-tonsillectomy hemorrhage. No primary post-tonsillectomy hemorrhage occurred. The hemorrhage was seen 6–13 days after the surgery. One patient had bleeding after having trauma to the neck on postoperative day 13. Of the 11 patients with post-tonsillectomy bleeding, 3 had blood clot with no active bleeding and 8 exhibited active bleeding after removal of blood clot. Of the 994 patients, 8 (0.8%) needed intervention to control active bleeding. Compared to previous studies of bipolar tonsillectomy, extended microscopic hemostasis achieved by cauterization of tonsil fossa non-bleeding blood vessels appeared to reduce bleeding rate after bipolar cautery tonsillectomy. The present study did not include a control arm; further randomized controlled studies are needed to establish the definite effect of extended microscopic hemostasis technique on the rate of hemorrhage rates after tonsillectomy techniques.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Hesham A (2009) Bipolar diathermy versus cold dissection in paediatric tonsillectomy. Int J Pediatr Otorhinolaryngol 73:793–795

    PubMed  Article  Google Scholar 

  2. Goycoolea MV, Cubillod PM, Martinez GC (1982) Tonsillectomy with a suction coagulator. Laryngoscope 92:818–819

    PubMed  Article  CAS  Google Scholar 

  3. Yuan CC, Yu DY, Jun TS (1984) Guillotine tonsillectomy without anaesthesia. Auris Nasus Larynx 11:29–35

    PubMed  CAS  Google Scholar 

  4. Martinez SA, Akin DP (1987) Laser tonsillectomy and adenoidectomy. Otolaryngol Clin North Am 20:371–376

    PubMed  CAS  Google Scholar 

  5. Szeremeta W, Novelly NJ, Benninger M (1996) Postoperative bleeding in tonsillectomy patients. Ear Nose Throat J 75:373–376

    PubMed  CAS  Google Scholar 

  6. Kristensen S, Tveteras K (1984) Post-tonsillectomy haemorrhage: a retrospective study of 1150 operations. Clin Otolaryngol 9:347–350

    PubMed  Article  CAS  Google Scholar 

  7. Rasmussen N (1987) Complications of tonsillectomy and adenoidectomy. Otolaryngol Clin North Am 20:383–390 (review)

    PubMed  CAS  Google Scholar 

  8. Conley SF, Ellison MD (1999) Avoidance of primary post-tonsillectomy hemorrhage in a teaching program. Arch Otolaryngol Head Neck Surg 125:330–333

    PubMed  CAS  Google Scholar 

  9. Irani DB, Berkowitz RG (1997) Management of secondary hemorrhage following pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol 40:115–124

    PubMed  Article  CAS  Google Scholar 

  10. Capper JWR, Randall C (1984) Post-operative haemorrhage in tonsillectomy and adenoidectomy in children. J Laryngol Otol 98:363–365

    PubMed  Article  CAS  Google Scholar 

  11. Breson K, Diepeveen J (1969) Dissection tonsillectomy: complications and follow-up. J Laryngol Otol 83:601–608

    PubMed  Article  CAS  Google Scholar 

  12. Carmody D, Vamadevan T, Cooper SM (1982) Post-tonsillectomy haemorrhage. J Laryngol Otol 96:635–638

    PubMed  Article  CAS  Google Scholar 

  13. Maniglia AJ, Kushner H, Cozzi L (1989) Adenotonsillectomy: a safe outpatient procedure. Arch Otolaryngol Head Neck Surg 115:92–94

    PubMed  Article  CAS  Google Scholar 

  14. Handler SD, Miller L, Richmond KH, Baranak CC (1986) Post-tonsillectomy hemorrhage: incidence, prevention and management. Laryngoscope 96:1243–1247

    PubMed  CAS  Google Scholar 

  15. Gabalski EC, Mattucci KF, Setzen M, Moleski P (1996) Ambulatory tonsillectomy and adenoidectomy. Laryngoscope 106:77–80

    PubMed  Article  CAS  Google Scholar 

  16. Weimert TA, Babyak JW, Richter HJ (1990) Electrodissection tonsillectomy. Arch Otolaryngol Head Neck Surg 116:186–188

    PubMed  Article  CAS  Google Scholar 

  17. Andrea M (1993) Microsurgical bipolar cautery tonsillectomy. Laryngoscope 103:1177–1178

    PubMed  Article  CAS  Google Scholar 

  18. Lee MSW, Montague ML, Hussain SSM (2004) Post-tonsillectomy haemorrhage: cold versus hot dissection. Otolaryngol Head Neck Surg 131:833–836

    PubMed  Article  Google Scholar 

  19. Pang YT (1995) Paediatric tonsillectomy: bipolar electrodissection and dissection/snare compared. J Laryngol Otol 109:733–736

    PubMed  Article  CAS  Google Scholar 

  20. Haddow K, Montague ML, Hussain SSM (2006) Post-tonsillectomy haemorrhage: a prospective, randomized, controlled clinical trial of cold dissection versus bipolar diathermy dissection. J Laryngol Otol 120:450–454

    PubMed  Article  CAS  Google Scholar 

  21. Silveira H, Soares JS, Lima HA (2003) Tonsillectomy: cold dissection versus bipolar electrodissection. Int J Pediatr Otorhinolaryngol 67:345–351

    PubMed  Article  Google Scholar 

  22. Kirazli T, Bilgen C, Midilli R, Ogut F, Uyar M, Kedek A (2005) Bipolar electrodissection tonsillectomy in children. Eur Arch Otorhinolaryngol 262:716–718

    PubMed  Article  Google Scholar 

  23. Atallah N, Kumar M, Hilali A, Hickey S (2000) Post-operative pain in tonsillectomy: bipolar electrodissection technique vs dissection ligation technique. A double-blind randomized prospective trial. J Laryngol Otol 114:667–670

    PubMed  Article  CAS  Google Scholar 

  24. MacGregor FB, Albert DM, Bhattacharyya AK (1995) Post-operative morbidity following paediatric tonsillectomy; a comparison of bipolar diathermy dissection and blunt dissection. Int J Pediatr Otorhinolaryngol 31:1–6

    PubMed  Article  CAS  Google Scholar 

  25. Pizzuto MP, Brodsky L, Duffy L, Gendler J, Nauenberg E (2000) A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Pediatr Otorhinolaryngol 52:239–246

    PubMed  Article  CAS  Google Scholar 

  26. Kujawski O, Dulguerov P, Gysin C, Lehmann W (1997) Microscopic tonsillectomy: a double-blind randomized trial. Otolaryngol Head Neck Surg 117:641–647

    PubMed  Article  CAS  Google Scholar 

  27. De Carpentier J, Timms M (1994) Preliminary experiences with microscopic tonsillectomy. Clin Otolaryngol Allied Sci 19:352–354

    PubMed  Article  Google Scholar 

  28. Gan K, Tomlinson C, El-Hakim H (2009) Post-operative bleeding is less after partial intracapsular tonsillectomy than bipolar total procedure. Int J Pediatr Otorhinolaryngol 73:667–670

    PubMed  Article  Google Scholar 

  29. Pang YT, el-Hakim H, Rothera MP (1994) Bipolar diathermy tonsillectomy. Clin Otolaryngol Allied Sci 19:355–357

    PubMed  Article  CAS  Google Scholar 

  30. Akkielah A, Kalan A, Kenyon GS (1997) Diathermy tonsillectomy: comparisons of morbidity following bipolar and monopolar microdissection needle excision. J Laryngol Otol 111:735–738

    PubMed  Article  CAS  Google Scholar 

  31. Lowe D, van der Meulen J (2004) National Prospective Tonsillectomy Audit. Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 364(9435):697–702

    PubMed  Article  CAS  Google Scholar 

  32. Hahn CH, Rungby JA, Overgaard T, Møller H, Schultz P, Tos M (2009) Effect of diathermy on pain and healing in tonsillectomy, compared with other methods of haemostasis: a randomised study. J Laryngol Otol 123:648–655

    PubMed  Article  CAS  Google Scholar 

  33. Lee KD, Lee HS, Hong JC, Yu TH, Lee HH, Chun BG, Gil YG, Kim KH (2008) Diameter of vessels across the tonsillar capsule as an anatomical consideration for tonsillectomy. Clin Anat 21:33–37

    PubMed  Article  Google Scholar 

  34. Myssiorek D, Alvi A (1996) Post-tonsillectomy hemorrhage: an assessment of risk factors. Int J Pediatr Otorhinolaryngol 37:35–43

    PubMed  Article  CAS  Google Scholar 

  35. Roberts C, Jayaramachandran S, Raine CH (1992) A prospective study of factors which may predispose to post-operative tonsillar fossa haemorrhage. Clin Otolaryngol Allied Sci 17:13–17

    PubMed  Article  CAS  Google Scholar 

  36. Schrock A, Send T, Heukamp L, Gerstner AO, Bootz F, Jakob M (2009) The role of histology and other risk factors for post-tonsillectomy haemorrhage. Eur Arch Otorhinolaryngol 266:1983–1987

    PubMed  Article  CAS  Google Scholar 

  37. Liu JH, Anderson KE, Willging JP, Myer CM 3rd, Shott SR, Bratcher GO, Cotton RT (2001) Posttonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg 127:1271–1275

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9035, USA

    Seckin O. Ulualp

  2. Division of Pediatric Otolaryngology, Children’s Medical Center, Dallas, TX, USA

    Seckin O. Ulualp

Authors
  1. Seckin O. Ulualp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seckin O. Ulualp.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ulualp, S.O. Rate of post-tonsillectomy hemorrhage after elective bipolar microcauterization of nonbleeding vessels. Eur Arch Otorhinolaryngol 269, 1269–1275 (2012). https://doi.org/10.1007/s00405-011-1774-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-011-1774-9

Keywords

  • Tonsillectomy
  • Hemorrhage
  • Bipolar cautery
  • Microscope