European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 1, pp 339–344 | Cite as

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

  • Jeong-Whun Kim
  • Sue Jean Mun
  • Woo-Hyun Lee
  • Ji-Hun Mo
Miscellaneous

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.

Keywords

Tonsillectomy Hemorrhage Diathermy Coblation Children Bias 

References

  1. 1.
    Shah UK, Dunham B (2007) Coblation for tonsillectomy: an evidence-based review. ORL J Otorhinolaryngol Relat Spec 69(6):349–357. doi:10.1159/000108367 PubMedCrossRefGoogle Scholar
  2. 2.
    Stoker KE, Don DM, Kang DR, Haupert MS, Magit A, Madgy DN (2004) Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study. Otolaryngol Head Neck Surg 130(6):666–675. doi:10.1016/j.otohns.2004.02.012 PubMedCrossRefGoogle Scholar
  3. 3.
    Benninger M, Walner D (2007) Coblation: improving outcomes for children following adenotonsillectomy. Clin Cornerstone 9(Suppl 1):S13–S23PubMedCrossRefGoogle Scholar
  4. 4.
    Mitic S, Tvinnereim M, Lie E, Saltyte BJ (2007) A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis. Clin Otolaryngol 32(4):261–267. doi:10.1111/j.1365-2273.2007.01468.x PubMedCrossRefGoogle Scholar
  5. 5.
    Wilson YL, Merer DM, Moscatello AL (2009) Comparison of three common tonsillectomy techniques: a prospective randomized, double-blinded clinical study. Laryngoscope 119(1):162–170. doi:10.1002/lary.20024 PubMedCrossRefGoogle Scholar
  6. 6.
    Shapiro NL, Bhattacharyya N (2007) Cold dissection versus coblation-assisted adenotonsillectomy in children. Laryngoscope 117(3):406–410. doi:10.1097/MLG.0b013e31802ffe47 PubMedCrossRefGoogle Scholar
  7. 7.
    Noordzij JP, Affleck BD (2006) Coblation versus unipolar electrocautery tonsillectomy: a prospective, randomized, single-blind study in adult patients. Laryngoscope 116(8):1303–1309. doi:10.1097/01.mlg.0000225944.00189.e9 PubMedCrossRefGoogle Scholar
  8. 8.
    Burton MJ, Doree C (2007) Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev (3):CD004619. doi:10.1002/14651858.CD004619.pub2
  9. 9.
    Lowe D, van der Meulen J (2004) Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 364(9435):697–702. doi:10.1016/S0140-6736(04)16896-7 PubMedCrossRefGoogle Scholar
  10. 10.
    Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M (2011) Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 121(2):279–288. doi:10.1002/lary.21242 PubMedCrossRefGoogle Scholar
  11. 11.
    Heidemann CH, Wallen M, Aakesson M, Skov P, Kjeldsen AD, Godballe C (2009) Post-tonsillectomy hemorrhage: assessment of risk factors with special attention to introduction of coblation technique. Eur Arch Otorhinolaryngol 266(7):1011–1015. doi:10.1007/s00405-008-0834-2 PubMedCrossRefGoogle Scholar
  12. 12.
    Kim DW, Koo JW, Ahn SH, Lee CH, Kim JW (2010) Difference of delayed post-tonsillectomy bleeding between children and adults. Auris Nasus Larynx 37(4):456–460. doi:10.1016/j.anl.2009.11.011 PubMedCrossRefGoogle Scholar
  13. 13.
    Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 127(1):13–21 S019459980200044XPubMedCrossRefGoogle Scholar
  14. 14.
    Clark MP, Smithard A, Jervis P (2006) How we do it: coblation tonsillectomy complication rates from a single ENT department compared with the National Prospective Tonsillectomy Audit. Clin Otolaryngol 31(2):156–159. doi:10.1111/j.1749-4486.2006.01172.x PubMedCrossRefGoogle Scholar
  15. 15.
    Mosges R, Hellmich M, Allekotte S, Albrecht K, Bohm M (2011) Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. Eur Arch Otorhinolaryngol 268(6):807–816. doi:10.1007/s00405-011-1535-9 PubMedCrossRefGoogle Scholar
  16. 16.
    Amir I, Belloso A, Broomfield SJ, Morar P (2011) Return to theatre in secondary post-tonsillectomy haemorrhage: a comparison of coblation and dissection techniques. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-011-1678-8 PubMedGoogle Scholar
  17. 17.
    Javed F, Sadri M, Uddin J, Mortimore S, Parker D (2007) A completed audit cycle on post-tonsillectomy haemorrhage rate: coblation versus standard tonsillectomy. Acta Otolaryngol 127(3):300–304. doi:10.1080/00016480600895052 PubMedCrossRefGoogle Scholar
  18. 18.
    Windfuhr JP, Deck JC, Remmert S (2005) Hemorrhage following coblation tonsillectomy. Ann Otol Rhinol Laryngol 114(10):749–756PubMedGoogle Scholar
  19. 19.
    Khan I, Abelardo E, Scott NW, Shakeel M, Menakaya O, Jaramillo M, Mahmood K (2011) Coblation tonsillectomy: is it inherently bloody? Eur Arch Otorhinolaryngol. doi:10.1007/s00405-011-1609-8 Google Scholar
  20. 20.
    Alexiou VG, Salazar-Salvia MS, Jervis PN, Falagas ME (2011) Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials. Arch Otolaryngol Head Neck Surg 137(6):558–570. doi:10.1001/archoto.2011.93 PubMedCrossRefGoogle Scholar
  21. 21.
    Belloso A, Chidambaram A, Morar P, Timms M (2003) Coblation tonsillectomy versus dissection tonsillectomy: postoperative hemorrhage. Laryngoscope 113(11):2010–2013PubMedCrossRefGoogle Scholar
  22. 22.
    Carney AS, Harris PK, MacFarlane PL, Nasser S, Esterman A (2008) The coblation tonsillectomy learning curve. Otolaryngol Head Neck Surg 138(2):149–152. doi:10.1016/j.otohns.2007.10.031 PubMedCrossRefGoogle Scholar
  23. 23.
    Mowatt G, Cook JA, Fraser C, McKerrow WS, Burr JM (2006) Systematic review of the safety of electrosurgery for tonsillectomy. Clin Otolaryngol 31(2):95–102. doi:10.1111/j.1749-4486.2006.01162.x PubMedCrossRefGoogle Scholar
  24. 24.
    Gallagher TQ, Wilcox L, McGuire E, Derkay CS (2010) Analyzing factors associated with major complications after adenotonsillectomy in 4776 patients: comparing three tonsillectomy techniques. Otolaryngol Head Neck Surg 142(6):886–892. doi:10.1016/j.otohns.2010.02.019 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Jeong-Whun Kim
    • 1
    • 2
  • Sue Jean Mun
    • 1
    • 3
  • Woo-Hyun Lee
    • 1
    • 2
  • Ji-Hun Mo
    • 4
  1. 1.Department of OtorhinolaryngologySeoul National University College of MedicineSeoulSouth Korea
  2. 2.Seoul National University Bundang HospitalSeongnamSouth Korea
  3. 3.Seoul National University HospitalSeoulSouth Korea
  4. 4.Department of OtorhinolaryngologyDankook University College of MedicineCheonanSouth Korea

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