Abstract
Abstract The aim of the study was to compare four different surgical techniques for tonsillectomy during free medical camps in Yemen, regarding type of anesthesia, complication rates, operative time, and cost of the operation. This prospective study was conducted from April 2006 to December 2011. There were 12 280 patients who underwent tonsillectomy in 26 hospitals in different Yemeni governorates, and operations were performed in 46 free medical camps. Under general anesthesia, we performed traditional dissection techniques (TDTs) and bipolar diathermy technique. Under local anesthesia, tonsillectomies were performed using TDT and guillotine excision technique. Of the 12 280 tonsillectomies patients, 53.7% were male patients and 46.3% were female patients. The median age of the patients was 11.5 years (range 3–30 years). Under general anesthesia, 6639 (54.1%) tonsillectomies were performed; of these, 86.1% were performed by TDT, whereas 13.9% were performed by bipolar diathermy technique. Under local anesthesia, 5641 (45.9%) tonsillectomies were performed; of these, 81% were performed by TDT, whereas 19% were performed by guillotine excision technique. Post-tonsillectomy hemorrhage was low in patients operated by TDT as compared with the other techniques. No significant differences were found in operative time between the four surgical techniques. The costs of tonsillectomy ranged between 30 and 37$. The TDT is the most common method performed in the free medical camps, is handy, favorite, less costly, and comfortable for our patients, and is suitable for our work environments, experiences, and equipments. We recommend this technique for the same circumstances as a day-case tonsillectomy. Although less postoperative hemorrhage was observed in traditional surgery under general anesthesia, surgery under local anesthesia is safer and less costly.
Highlights
Tonsillectomy is one of the most common surgical procedures performed worldwide
Primary hemorrhage occurred in 114 (2.5%) patients subjected to traditional dissection techniques (TDTs) compared with 42 (4%) patients who underwent guillotine excision technique (GET)
The primary hemorrhage was higher in bipolar diathermy dissection, and this may be due to the use of ties routinely during cutting the tonsils to control the bleeding in patients subjected to TDT
Summary
Tonsillectomy is one of the most common surgical procedures performed worldwide. There is still controversy over which is the optimal technique of tonsillectomy with the lowest morbidity rates. All the techniques have certain advantage and disadvantage. Any improvement of this procedure should decrease operating time, postoperative hemorrhage, and the postoperative morbidity [6]. General anesthesia is invariably used in performing tonsillectomy in children, whereas local or general anesthesia can be used in adult patients. Local anesthesia is generally regarded as a safer procedure than general anesthesia. The objective of this study was to compare the different surgical techniques for tonsillectomy during free medical camps in Yemen, regarding anesthesia type, complication rates including primary and secondary hemorrhage, operative time, and the cost of tonsillectomies carried out
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