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Evaluation of Anterior and Posterior Pillar Suturing Following Adult Tonsillectomy in Terms of Hemorrhage, Pain, and Dysphagia Complications

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Abstract

Tonsillectomy is one of the most common surgical procedures performed by otolaryngologists. Postoperative complications, although rare, can be observed in tonsillectomy. This study aimed to investigate the effect of anterior and posterior pillar suturing on dysphagia, hemorrhage, and pain complications following tonsillectomy in adult patients. The study included 80 patients (32 males, 48 females; > 18 years) who underwent tonsillectomy. The patients were divided into two groups: Group 1, in which the tonsillar lodge was closed by anterior–posterior pillar suturing with a 3–0 chromic catgut suture after hemostatic compression and Group 2, in which the tonsillar lodge was exposed following hemostatic compression and bipolar cauterization. Post-surgical pain was assessed using the Numeric Rating Scale (NRS). Oropharyngeal dysphagia was evaluated using the Eating Assessment Tool (EAT)-10. None of the patients experienced postoperative primary hemorrhage. However, postoperative secondary hemorrhage was observed in seven patients, two from Group 1 and five from Group 2. There was no significant difference in postoperative hemorrhage between the two groups (p = 0.449). Furthermore, no statistically significant difference was observed between the two groups in terms of the NRS scores on postoperative day 1 and at postoperative week 2 (p = 0.130 and 0.142, respectively) or the EAT-10 scores at postoperative week 2 and postoperative month 6 (p = 0.925 and 0.090, respectively). Anterior–posterior pillar suturing, which is performed for hemorrhage control after tonsillectomy, is not superior to the conventional bipolar method in terms of postoperative dysphagia, hemorrhage, and pain.

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References

  1. Ostvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E et al (2015) Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol 272(3):737–743. https://doi.org/10.1007/s00405-014-3312-z

    Article  Google Scholar 

  2. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA et al (2019) Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg 160(1):S1-42. https://doi.org/10.1177/0194599818801757

    Article  Google Scholar 

  3. Robinson SR, Purdie GL (2000) Reducing post-tonsillectomy pain with cryoanalgesia: A randomized controlled trial. Laryngoscope 110:1128–1131. https://doi.org/10.1097/00005537-200007000-00011

    Article  CAS  Google Scholar 

  4. Pynnonen M, Brinkmeier JV, Thorne MC, Chong LY, Burton MJ (2017) Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 8:CD004619. https://doi.org/10.1002/14651858.CD004619.pub3

  5. Garnett JD, Ramadan HH (1996) Swallowing dysfunction after tonsillectomy. Otolaryngol Head Neck Surg 114:813–817. https://doi.org/10.1016/S0194-59989670108-0

  6. Karcioglu O, Topacoglu H, Dikme O, Dikme O (2018) A systematic review of the pain scales in adults: Which to use? Am J Emerg Med 36(4):707–714. https://doi.org/10.1016/j.ajem.2018.01.008

    Article  Google Scholar 

  7. Belafsky PC, Mouadeb DA. Rees CJ, Pryor JC, Postma N, Allen J et al (2008) Validity and reliability of the Eating Assessment Tool (EAT10). Ann Otol Rhinol Laryngol 117(12): 919–924. https://doi.org/10.1177/000348940811701210

  8. Goldman JL, Baugh RF, Davies L, Skinner ML, Stachler RJ, Brereton J et al (2013) Mortality and major morbidity after tonsillectomy. Laryngoscope 123:2544–2553. https://doi.org/10.1002/lary.23926

  9. Wei J, Beatty C, Gustafon R (2000) Evaluation of posttonsillectomy hemorrhage and risk factors. Otolaryngol Head Neck Surg 229–235. https://doi.org/10.1067/mhn.2000.107454

  10. Windfuhr JP (2003) Lethal post-tonsillectomy hemorrhage. Auris Nasus Larynx 30(4):391–396. https://doi.org/10.1016/j.anl.2003.07.004

    Article  Google Scholar 

  11. Randall DA, Hoffer ME (1998) Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 118(1):61–68. https://doi.org/10.1016/s0194-5998(98)70376-6

    Article  CAS  Google Scholar 

  12. Blakley BW (2009) Post-tonsillectomy bleeding: how much is too much? Otolaryngol Head Neck Surg 140(3):228–290. https://doi.org/10.1016/j.otohns.2008.12.005

    Article  Google Scholar 

  13. Ikoma R, Sakane S, Niwa K, Kanetaka S, Kawano T, Oridate N (2014) Risk factors for post-tonsillectomy hemorrhage. Auris Nasus Larynx 41:376–379. https://doi.org/10.1016/j.anl.2014.02.007

  14. Aljabr IK, Hassan FM, Alyahya KA (2016) Post-tonsillectomy hemorrhage after bipolar diathermy versus cold dissection surgical techniques in Alahsa region. Alexandria J Med 52:169–172. https://doi.org/10.1016/j.ajme.2015.06.004

  15. Windfuhr JP, Chen YS, Remmert S (2005) Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 132:281–286. https://doi.org/10.1016/j.otohns.2004.09.007

  16. Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M (2011) Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 121:279–288. https://doi.org/10.1002/lary.21242

  17. J Mueller, D Boeger, J Buentzel, D Esser, K Hoffmann, P Jecker et al (2015) Population-based analysis of tonsil surgery and postoperative hemorrhage. Eur Arch Otorhinolaryngol 272:3769–3777 https://doi.org/10.1007/s00405-014-3431-6

  18. 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. https://doi.org/10.1007/s00405-009-0958-z

  19. Gonçalves AI, Rato C, de Vilhena D, Duarte D, Lopes G, Trigueiros N (2020) Evaluation of post-tonsillectomy hemorrhage and assessment of risk factors. Eur Arch Otorhinolaryngol 277:3095–3102. https://doi.org/10.1007/s00405-020-06060-1

  20. Boğrul MF, Ünal A, Yılmaz F, Sancaktar ME, Bakırtaş M (2019) Comparison of two modern and conventional tonsillectomy techniques in terms of postoperative pain and collateral tissue damage. Eur Arch Otorhinolaryngol 276:2061–2067. https://doi.org/10.1007/s00405-019-05464-y

    Article  Google Scholar 

  21. Tas E, Hanci V, Ugur MB, Turan IO, Yigit VB, Çınar F (2010) Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation. Int J Pediatr Otorhinolaryngol 74(10):1171–1175. https://doi.org/10.1016/j.ijporl.2010.07.007

    Article  Google Scholar 

  22. Cokkeser Y, Akbay E, Cevik C, Mutlu O, Karaoglu E (2013) A prospective self controlled trial to evaluate post operative pain after tonsillectomy by suturing Plica Tonsillaris. Int J Basic Clin Study 2(2):81–87

    Google Scholar 

  23. Hong SA, LaGorio L, Husain I (2020) Post-tonsillectomy dysphagia secondary to glossopharyngeal nerve injury. BMJ Case Rep 13(1):e232657. https://doi.org/10.1136/bcr-2019-232657

    Article  Google Scholar 

  24. Ford LC, Cruz RM (2004) Bilateral glossopharyngeal nerve paralysis after tonsillectomy: case report and anatomic study. Laryngoscope 114:2196–2199. https://doi.org/10.1097/01.mlg.0000149457.13877.d5

    Article  Google Scholar 

  25. Demir N, Serel Arslan S, İnal Ö, Karaduman AA (2016) Reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10). Dysphagia 31(5):644–649. https://doi.org/10.1007/s00455-016-9723-9

    Article  Google Scholar 

  26. Ersöz Unlü EC, Akın Oçal FC (2020) Can Eating Assessment Tool (EAT-10) anticipate objective findings of dysphagia patients? Kbb ve Bbc Dergisi 28(2):146–151. https://doi.org/10.24179/kbbbbc.2020-75224

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Correspondence to Mehmet Ali Say.

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The authors declare that they have no conflict of interest. There is no financial interest to disclose.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Bülent Ecevit University (Date: 08.05.2020/Number: 16).

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Informed consent was obtained from all the individual participants included in the study.

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Say, M.A., Bilgin, E. & Baklacı, D. Evaluation of Anterior and Posterior Pillar Suturing Following Adult Tonsillectomy in Terms of Hemorrhage, Pain, and Dysphagia Complications. Indian J Otolaryngol Head Neck Surg 74 (Suppl 3), 5624–5629 (2022). https://doi.org/10.1007/s12070-021-02965-3

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