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Int J Otolaryngol. 2017;2017:8430907. doi: 10.1155/2017/8430907. Epub 2017 Aug 8.

Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study.

Author information

1
Department Otolaryngology, Head/Neck & Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany.
2
Department Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, Marburg, Germany.
3
Department Otolaryngology, Head and Neck Surgery, Borromäus Hospital Leer, Leer, Germany.

Abstract

BACKGROUND:

Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic) could be assumed to decrease PTH compared to traditional tonsillectomy (TEtrad).

METHODS:

In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured.

RESULTS:

869 patients were included (183 TEmic; 686 TEtrad). PTH requiring RTT was not seen in the TEmic group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TEmic group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TEtrad were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p > 0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p = 0.007).

CONCLUSION:

Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TEmic group. Benefit for TEmic was observed in high-volume and long experienced surgeons.

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