Routine tonsillar bed oversew after diathermy tonsillectomy: does it reduce secondary tonsillar haemorrhage?

Significantly reducing post-tonsillectomy hemorrhage requiring surgery by double-layer suture: A retrospective analysis

BACKGROUND

Although tonsillectomies carry a low-risk for adverse events, postoperative hemorrhage has been reported as the most common complication.

AIM

To compare the rates of postoperative secondary hemorrhage for tonsillectomy with or without double-layer suture.

MATERIAL AND METHODS

This is a retrospective study of 5087 patients who underwent coblation tonsillectomy with or without suture from 2006 to 2016. All cases had been followed up 3 weeks and severe secondary hemorrhage cases requiring operation were analyzed.

RESULTS

The severe secondary hemorrhage rate was statistically higher in group without suture (1.96%) as compared with the group with suture (1.08%). The surgery time (36.55 ± 7.45) was longer in patients with suture as compared to patients without suture (31.50 ± 6.23). In the age between 18 and 49 years group, the higher secondary hemorrhage rate (2.44%) was found in patients without suture. The rate of postoperative hemorrhage (0.96%) was significantly higher in patients without suture as compared with patients with suture (0.36%) on postoperative 5th day.

CONCLUSIONS

The risk of severe secondary hemorrhage is reduced in coblation tonsillectomy with suture. The rate of secondary hemorrhage is lower in patients with suture in 18 to 49 years old group and on the 5th day after surgery.

Does suturing tonsil pillars post-tonsillectomy reduce postoperative hemorrhage?: A literature review

OBJECTIVE

Literature review comparing post-tonsillectomy hemorrhage in pediatric and adult patients with and without suturing tonsil pillars to investigate whether suturing tonsil pillars reduces the risk of post-tonsillectomy hemorrhage.

REVIEW METHODS

Online journal databases were searched using the key phrases "post tonsillectomy hemorrhage", "post tonsillectomy bleed", and "tonsil pillar suture". 10 published studies were found regarding tonsil pillar suturing, four directly related to postoperative bleeding and five focusing on postoperative pain reduction. There was one study that evaluated both pain and bleeding. The pain reduction studies were comprised of 225 patients while the postoperative bleeding studies included 3987 patients.

CONCLUSIONS

Suturing tonsil pillars after tonsillectomy may be beneficial after cold tonsillectomy.

IMPLICATIONS FOR PRACTICE

Post-operative bleeding is one of the most common complications that can result in increased patient distress and hospitalization. In this article, we provide a literature review of tonsil pillar suturing and post-tonsillectomy hemorrhage. Our study suggests suturing the tonsil pillars immediately post-tonsillectomy may reduce the risk of severe post-operative bleeding requiring return to the operating room for certain patients.