THE EFFECTIVENESS OF LOWER POLE LIGATION IN TONSILLECTOMY

Muhammad Saleem Muhammad Saleem,Nisar Akbar Khan Nisar Akbar Khan,Baber Raﬁque Baber Raﬁque,Danish Hassnain Danish Hassnain,Khizar Saleem Khizar Saleem

doi:10.37723/jumdc.v10i1.25

Muhammad Saleem Muhammad Saleem, Nisar Akbar Khan Nisar Akbar Khan + Show 3 more

Open Access

https://doi.org/10.37723/jumdc.v10i1.25

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Abstract

OBJECTIVE: Hemorrhage following tonsillectomy has always been a serious problem. Recently several techniques, devices and materials have been developed to reduce the intra-operative and post-operative blood loss but still no optimal methods have emerged. In this study we assessed the eﬀectiveness of lower pole ligation in tonsillectomy ensuring the hemostasis and preventing the post-operative hemorrhage in early and late stages. MATERIALS AND METHODS: This was a hospital based retrospective study performed in the department of ENT, Aziz Fatima Hospital (Medical College) and Faisal Hospital Faisalabad from May 2014 to June 2017. During this period 310 patients underwent tonsillectomy using COLD DISSECTION TECHNIQUE. Inferior pole was ligated by Negus artery forceps as close to its junction with the lingual tonsils ensuring no tissue remnants are left and knot applied by Negus ligature carrier with Black Silk #1. Bipolar diathermy was used for tonsillar bed hemostasis. Follow-up was continued for the next 4 weeks. RESULTS: Out of 310 patients undergoing the procedure only 2 presented with reactionary hemorrhage. One of them presented after 3 hours and the cause of bleeding was appreciated as slipping of the knot from the lower pole which was shifted to OT and ligated again using the Silk # 1. Second patient presented after 2 hours with mild reactionary hemorrhage and the site was not from the lower pole, but diﬀuse oozing from the tonsillar bed which was conservatively dealt by cold sponging and ice cold gargles. Out of 310 only 1 patient presented after 3 weeks with secondary hemorrhage which was treated by broad spectrum antibiotics. CONCLUSION: The use of lower pole ligation in tonsillectomy aﬀords eﬃcient and practical hemostasis. The procedure is inexpensive and requires no special and reﬁned equipment. The anterior and posterior tonsillar pillars remained intact thus the functional anatomy was preserved.

Highlights

Tonsillectomy is one of the most commonly done surgical procedures in the world.[1]
The aim of this study is to demonstrate the effectiveness of lower pole ligation technique in ensuring hemostasis intraoperatively and preventing post tonsillectomy hemorrhage in early and late stage and to compare the results with international literatures
[14] Bleeding is the major source of morbidity and mortality in tonsillectomy and most of the post operative time spent in securing the hemostasis [15, 16]and this bleeding is mostly from the lower pole. [9,15,16,1] The bleeding was less in inferior pole ligation method probably due to dealing with the offending vessels, by competent and secured way of hemostasis which was inferior pole ligation of the pedicle

Summary

Introduction

Tonsillectomy is one of the most commonly done surgical procedures in the world.[1]. The incidence of post-operative hemorrhage ranges from 0.3% to 12 %.[1,5] Hemorrhage is still considered to be the most serious complication of this procedure. [1] Mortality rate varies from 1/12000 to 1/75000. [1] The risk factors for post tonsillectomy hemorrhage are older age, lack of preparation for surgery pre-operatively, excessive intra-operative blood loss by inexpert hands, elevated post-operative mean arterial blood pressure, short neck, obesity, and bulky tongue.[1, 6] a day's different methods are used for tonsillectomy e.g. blunt dissection, cold methods, electro cautery or hot methods like lasers and coblation methods. Additional sources are from ascending pharyngeal artery and the lesser palatine artery at upper pole Due to this fact hemorrhage commonly seen on the lower pole.[4] There are few suture or tie ligature techniques that is slip knot, under suture, clipping with negus artery forceps and applying knot with ligature carrier. These techniques may vary from surgeon to surgeon. The aim of this study is to demonstrate the effectiveness of lower pole ligation technique in ensuring hemostasis intraoperatively and preventing post tonsillectomy hemorrhage in early and late stage and to compare the results with international literatures

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Results

Discussion

Conclusion