gms | German Medical Science

Introduction: Bleeding remains the most significant complication following tonsillectomy. Post-tonsillectomy hemorrhage (PTH) is classified either as primary (PB; <24 h) or secondary bleeding (SB; >24 h). This retrospective study was undertaken to identify whether the incidence of PTH and SB is related to bipolar electrocautery or not.

Objective: To identify the rate of post-tonsillectomy hemorrhage (PTH) either after cold dissection followed by intraoperative bipolar electrocautery (Group A) or suture ligation (Group B) to achieve hemostasis.

Methods: A total of 2,740 patients who had undergone tonsillectomy between February, 2008 and June, 2012 were included in the study. Group A consisted of 1,557 patients and 1.183 patients were recruited for Group B. Bleeding episodes were counted, if they required surgical treatment under general anesthesia.

Results: No significant differences between both groups in the epidemiological data were identified. PTH occurred in 82 patients of group A (5.3%) and 51 patients of group B (4.4%). Recurrent bleeding was experienced by 9 patients of group A (0.58%) and in 4 patients of group B (0.34%). The latest bleeding episode in group A occurred on day 18 and 11 days after tonsillectomy in group B patients. While the rate of PB increased from 17% to 67%, the rate of SB significantly decreased, when bipolar electrocautery was replaced by suture ligation 83% to 33%.

Conclusion: The total rate of PTH appears not to be significantly influenced by the surgical technique. However, the risk of SB and repeated episodes of PTH is significantly reduced, when bipolar electrocautery to achieve intraoperativ hemostatis is replaced by intraoperative suture ligation.