Sluder banned from France!

Abstract

Sir, Last spring the French Joint Commission (Haute Autoritede Sante ´, the independent scientific author- ity for quality of care) issued a recommendation banning the Sluder tonsillectomy from coverage by the public health care reimbursement scheme (1). Greenfield Sluder (18651928) presented this method in 1910 (2). The instrument of Sluder- Ballenger, incorrectly called the guillotine, given that its principle was based on pulling-out rather than cutting, played a critical role in the evolution of tonsil surgery. It led to the end of one era of tonsil surgery, tonsillotomy, and the beginning of another, tonsillectomy. Indeed, surgeons were comfortable with this instrument and performed tonsillectomy without having to learn a surgical technique and using several instruments. Now, various techniques are available, based upon dissection and/or the use of cauterization (ultrasound, radiofrequency, thermal energy, laser, microdebrider, etc.). However, in France 9% are still faithful to the instrument of Sluder-Ballenger (3). The Commission working group associated five medical experts, all against the Commission's recommendation. Indeed, there is no scientific evidence showing that post-tonsillectomy complica- tions are technique-dependent. All data suggest that the Sluder tonsillectomy is safe and, in contrast, dissection may be responsible for more serious hemorrhage due to peri-tonsillar artery injury. The recommendation did not mention the expert's posi- tion. The pediatric otolaryngology society failed to get the decision repealed. One can question the Commission's indepen- dence and scientific rationale. We question the consequences for the patients: numerous surgeons will have to perform a new technique, without a supervision plan during the learning period.