Cerrahi Teknik Post Tonsillektomi Hemoraji Oranını Anlamlı Olarak Değiştirir mi?

Year 2018, , 7 - 10, 03.08.2018

Yusuf Dündar Hümeyra Bayram Akcan Derya Cebeci Ahmet Uluat , Fatih Alper Akcan

https://doi.org/10.18678/dtfd.444200

Abstract

Amaç: Tonsillektomi pediatrik populasyonda en sık uygulanan cerrahi girişimlerden biridir ve KBB eğitiminde ilk öğrenilen işlemlerdendir. Bu çalışma, tonsillektomi sonrası kanamada cerrahi tekniğin etkili olup olmadığını değerlendirmeyi amaçlamıştır.

Gereç ve Yöntemler: Bu prospektif planlı klinik çalışma, Mayıs 2012 ile Nisan 2015 arasında bir üçüncü basamak sağlık merkezinde gerçekleştirildi. Çalışma süresince, aynı cerrah tarafından 3 farklı teknikle toplam 608 hasta ameliyat edildi. Grup 1'de soğuk diseksiyon ile ameliyat edilen çocuklar, Grup 2'de bipolar koter ile opere edilen çocuklar, Grup 3’de ise posterior pillar mukozal sütür tekniği ile opere edilen çocuklar yer aldı.

Bulgular: Soğuk diseksiyon (n=165), bipolar koter (n=274) ve posterior pillar mukozal sütür (n=169) tekniklerine toplam 608 hasta dahil edildi. Yaş ortancası 5 (2-14) idi. Beş hastada (%0,82) ameliyat sonrası kanama oldu. Bu hastalardan sadece birinde primer hemoraji gözlenmiş olup, hasta soğuk diseksiyon grubunda yer almaktaydı. Beş hastanın dördünde sekonder kanama gözlendi ve bu hastalar bipolar koter grubu ve posterior pillar mukozal sütür gruplarındaydı. Postoperatif hemoraji oranları gruplar için sırasıyla %0.61, %0,73 ve %1,18 olarak tespit edildi (p=0,861). Kanamayı kontrol etmek için ameliyat odasına sadece beş hastadan biri transfer edildi.

Sonuç: Çalışmamızın bulguları, cerrahi tekniğin tonsillektomi sonrası kanama oranını etkilemediğini desteklemektedir. Farklı cerrahi teknikler arasında primer ve sekonder kanamada oranları açısından anlamlı fark olmadığı görüldü.

Keywords

Tonsillektomi, bipolar koter, soğuk diseksiyon, post-tonsillektomi hemoraji

Does Surgical Technique Significantly Change the Rate of Post-Tonsillectomy Hemorrhage?

Abstract

Aim: Tonsillectomy is one of the most common surgical procedures in the pediatric population, as well as one of the first operations learned during otolaryngology residency. This study aims to evaluate the effect of surgical technique on the occurrence of post-tonsillectomy hemorrhage.

Material and Methods: This prospectively-designed clinical trial was conducted in a tertiary referral center between May 2012 and April 2015. A total of 608 patients had tonsillectomies performed by a single surgeon with three different surgical techniques used during the study period. Patients in group one were operated on using cold dissection; group two comprised patients who underwent bipolar cautery; group three had the posterior pillar mucosal suturing technique performed.

Results: 608 patients met inclusion criteria; 165 of them in group one, 274 in group two, and 169 in group three. The median age was 5 (2-14) years old. A total of five patients (0.82%) experienced post-operative bleeding. One of these patients (from group one) experienced primary hemorrhage. The four others were considered secondary hemorrhage; two from each the bipolar cautery and posterior pillar mucosal suturing groups. The rates of post-operative hemorrhage in each group were 0.61%, 0.73% and 1.18%, respectively (p=0.861). Only one of the five patients necessitated a return to the operating room to control the bleeding.

Conclusion: Our study findings suggest that the choice of surgical technique does not affect the post-tonsillectomy bleeding rate. There were no significant differences in bleeding rates between subgroups.

Keywords

Tonsillectomy, bipolar cautery, cold dissection, post-tonsillectomy hemorrhage

References

• K.A. Cullen, M.J. Hall, A. Golosinskiy, Ambulatory Surgery in the United States, 2006, Natl.Health Stat.Report. 11 (2009) 1-25.
• J.P. Windfuhr, Y.S. Chen, S. Remmert, Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients, Otolaryngol. Head Neck Surg. 132 (2006) 281-6.
• C. Gysin, P. Dulguerov, Hemorrhage after tonsillectomy: does the surgical technique really matter? ORL. J. Otorhinolaryngol. Relat. Spec. 75 (2013) 123-32.
• T.A. Weimert, J.W. Babyak, H.J. Richter, Electrodissection tonsillectomy, Arch Otolaryngol Head Neck Surg. 116 (1990) 186-8.
• S.P. Parsons, S.R. Cordes, B. Comer, Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator and electrocautery, Otolaryngol. Head Neck Surg. 134 (2006) 106-13.
• V.A. Lachanas, J.K. Hajiioannou, G.T. Karatzias, D. Filios, S. Koutsias, C. Mourgelas et al, Comparison of liga-sure vessel sealing system, harmonic scalpel and cold knife tonsillectomy, Otolaryngol. Head Neck Surg. 137 (2007) 385-9.
• J.A. Roth, T. Pincock, R. Sacks, M. Forer, N. Boustred, W. Johnston et al, Harmonic scalpel tonsillectomy versus monopolar diather study, Ear Nose Throat J. 87 (2008) 346-9.
• M. Duval, J. Wilkes, K. Korgenski, R. Srivastava, J. Meier, Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children, Int. J. Pediatr. Otorhinolaryngol. 79 (2015) 1640-6.
• J. Mueller, D. Boeger, J. Buentzel, D. Esser, K. Hoffmann, P. Jecker, et al, Populationbased analysis of tonsil surgery and postoperative hemorrhage, Eur. Arch. Otorhinolaryngol. 272 (2015) 3769-77.
• D. Lowe, J. van der Meulen, National Postoperative Tonsillectomy Audit, Lancet. 364 (2004) 697–702.
• N. Bhattacharyya, N.L. Shapiro, Associations between socioeconomic status and race with complications after tonsillectomy in children, Otolaryngol. Head. Neck. Surg. 151 (2014) 1055–1060.
• R.F. Baugh, S.M. Archer, R.B. Mitchell, et al, Clinical practice guideline: tonsillectomy in children, Otolaryngol. Head Neck Surg. 144 (2011) 1-30.
• A. Tomkinson, W. Harrison, D. Owens, S. Harris, V. McClure, M. Temple, Risk factors for postoperative hemorrhage following tonsillectomy, Laryngoscope. 121 (2011) 279-88.
• A.C. Söderman, E. Odhagen, E. Ericsson, C. Hemlin, E. Hultcrantz, O. Sunnergren et al, Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden, Clin. Otolaryngol. 40 (2015) 248-54.
• F.K. Soy, R. Dündar, H. Yazici, E. Kulduk, M. Aslan, E.U. Sakarya, Bipolar cautery tonsillectomy using different energy doses: pain and bleeding, Int. J. Pediatr. Otorhinolaryngol. 78 (2014) 402-6.
• H.M. Hegazy, O.A. Albirmawy, A.H. Kaka, A.S. Behiry, Pilot comparison between potassium titanyl phosphate laser and bipolar radiofrequency in paediatric tonsillectomy, J. Laryngol. Otol. 122 (2008) 369-73.
• D.M. Beswick, C. Santa Maria, N.F. Ayoub, R. Capasso, P.L. Santa Maria, Epithelial separation theory for post-tonsillectomy secondary hemorrhage: evidence in a mouse model and potential heparin-binding epidermal growth factor-like growth factor therapy, Eur. Arch. Otorhinolaryngol. 275 (2018) 569-78.
• Royal College of Surgeons of England. National Prospective Tonsillectomy Audit: Final Report. London: Royal College of Surgeons of England, 2005.
• T.Q. Gallagher, L. Wilcox, E. McGuire, C.S. Derkay, Analyzing factors associated with major complications after adenotonsillectomy in 4776 patients: comparing three tonsillectomy techniques, Otolaryngol. Head Neck Surg. 142 (2010) 886-92.
• A.D. Hinton-Bayre, K. Noonan, S. Ling, S. Vijayasekaran, Experience is more important than technology in paediatric post-tonsillectomy bleeding, J. Laryngol. Otol. 131 (2017) 35-40.