Terms Of Postoperative Bleeding Research Articles

Medial Flap Coblation Turbinoplasty Versus Submucous Resection: Outcomes.

Variable surgical options are available for turbinate reduction. These options include total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryosurgery, electrocautery, radiofrequency ablation, and turbinate out-fracture. However, there remains a lack of consensus for the preferred technique. The aim of this study was to describe the use of coblation for medial flap turbinoplasty procedure. Furthermore, the outcomes of this technique were compared to submucous resection in terms of improvement of patients' symptoms, postoperative bleeding, crusting, and pain scores. This prospective, randomized, comparative surgical trial was conducted on 90 patients. Patients were randomly allocated into 2 groups: medial flap coblation turbinoplasty group (n = 45), and submucous resection group (n = 45). The outcomes of both techniques were analyzed and compared. Both techniques were equally in alleviating patients' symptoms of nasal obstruction. However, postoperative healing was significantly better in medial flap coblation turbinoplasty group. Additionally medial flap turbinoplasty showed a statistically significant better outcome in terms of postoperative bleeding, crusting and pain scores. Both submucous resection and medial flap coblation turbinoplasty are effective in relieving nasal obstruction and enabling optimal volume reduction with preservation of function of the inferior turbinate. Coblation turbinoplasty has superior outcomes in terms of better healing and less postoperative pain and crusting.

Correct Stapling Technique in Laparoscopic Sleeve Gastrectomy: Are We Increasing the Bleeding? A Prospective Cohort Study.

Introduction: Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric surgery procedure. Bleeding is the most common complication of this surgery and mostly occurs from the staple line. The aim of this study was to evaluate whether waiting between compression and firing during the stapling phase reduces the postoperative bleeding. Methods: A total of 325 patients who underwent LSG between April and July 2022 were analyzed prospectively. In terms of postoperative bleeding, the two groups, which we waited 30 seconds between staple firings and the no wait group, were compared. Results: The mean age of patients was 37.36 (±11.12) years and mean body mass index was 45.18 (±3.1) kg/m2. Eleven patients needed transfusion. The rate of haemorrhagic complications was 3.38% (Group 1% 6.21 and Group 2% 1.11) (P = .012). The duration of surgery was ∼10 minutes longer in the study group, which we waited (P = .0001). Conclusions: During the stapling stage in LSG, waiting between compression and firing can help reduce postoperative bleeding.

EFFECTIVENESS OF DRAINLESS THYROIDECTOMY IN TERMS OF POSTOPERATIVE BLEEDING-A RANDOMIZED CONTROLLED TRIAL

Objective: To determine the effectiveness of drainless thyroidectomy in terms of postoperative bleeding. Subject and methods: This randomized controlled trial was conducted in Khyber Teaching Hospital on 40 patients from January 2019 to December 2019 after getting ethical approval from the hospital ethical committee. Two groups were allocated consisting of 20 patients, one with drainage and one without drainage, and were observed for bleeding during their stay in the hospital postoperatively. Data was collected using SPSS-21 to compare the effectiveness of both the procedures and the results were described in the form of tables. Results: The difference in complication rates was not significant in the two groups. In the drainless group, two cases of seroma (5%) were noted in both groups. One case of hematoma was observed in the drain group. No case of hematoma was reported in the drainless group. Conclusion: The use of drainless thyroidectomy can be justified based on the available data in this study where no bleeding was observed in the intervention group. Keywords: Thyroidectomy, drains, post-operative complications

A multi-centre randomized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the buccal aspect of single implants: 3-month results.

To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of changes over time in buccal soft tissue profile (BSP) when applied at single implant sites. Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi-centre randomized controlled trial. All sites had a bucco-palatal bone dimension of at least 6 mm and received a single implant and immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX: Geistlich Fibro-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland) to increase buccal soft tissue thickness. Primary outcome was increase in BSP at T1 (immediately after operation) and T2 (3months) based on superimposed digital surface models. Secondary parameters included patient-reported clinical and aesthetic outcomes. Thirty patients were included per group (control: 50% females, mean age 50; test: 53% females, mean age 48). Even though surgeons applied thicker grafts when using CMX, sites treated with CMX demonstrated 0.78 mm (95% CI 0.41-1.14) more shrinkage between T1 and T2 than sites treated with CTG. The final increase in BSP was 1.15 mm (95% CI 0.88-1.43) for CTG and 0.85 mm (95% CI 0.58-1.13) for CMX. The mean difference of 0.30 mm (95% CI -0.01 to 0.61) at T2 in favour of CTG was of borderline significance (p=.054). There were no significant differences between the groups in terms of post-operative bleeding (p=.344), pain (p=.331), number of analgesics taken (p=.504), oedema (p=.227), and pink aesthetic score (p=.655). VAS for post-operative haematoma was 6.56 (95% CI 0.54-12.59) lower for CMX, and surgery time could be reduced by 9.03 min (95% CI 7.04-11.03) when applying CMX. However, CMX resulted in significantly more marginal bone loss (0.38 mm; 95% CI 0.15-0.60), deeper pockets (0.30 mm; 95% CI 0.06-0.54), and more mid-facial recession (0.75 mm; 95% CI 0.39-1.12) than CTG. CTG remains the gold standard for increasing soft tissue thickness at the buccal aspect of implants.

Differences in Surgical Outcome in Near Total Thyroidectomy for Benign Nodular Goiter: A Comparison of LigaSure Vessel Sealer versus Conventional Clamp Knot Tie Technique

Objective: To compare the efficacy of LigaSure Vessel Sealer in Near Total Thyroidectomy versus Conventional Clamp Knot Tie Technique in terms of bleeding, operative time and postoperative drainage.
 Methodology: This comparative cross sectional study was conducted at Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro. Study duration was one year from November 2019 to October 2020. All patients of any age with benign multinodular goiter and either of gender were included. The study subjects were grouped into two categories by randomization (odd / even). The odd numbers were given to patients operated for ligasure and even numbers were given to patients operated with conventional clamp knot tie technique. Outcomes were observed with respect to post-operative calcium level, intra-operative bleeding, operative time, post-operative pain & post-operative hospital stay. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20.
 Results: Total 55 patients were observed. Mean age was 33.25±10.60 years in clamp knot tie procedure group and 35.16±07.96 years in ligasure technique group; without significant difference (p-0.448). Pre and post-operative calcium levels were statistically insignificant among both groups (p-0.358 and 0.163), while loss of blood, hospital stay, post-operative pain and operative duration were significantly greater in clamp knot tie technique group in comparison to ligasure technique group (p-<0.001).
 Conclusion: LigaSure Vessel Sealer is a feasible and reliable surgical technique and significantly more effective as compared to conventional clamp knot tie technique in terms of post-operative bleeding, operative time, post-operative pain and post-operative hospital stay. However, calcium level was statistically insignificant.

An Argument for the Safety of Immediate Device Reconstruction following Mastectomy during the COVID-19 Crisis

Background:Although oncologic surgery is deemed urgent during the COVID-19 pandemic, clinical guidelines in reconstructive surgery have been unclear. Utilizing propensity-matched pre-pandemic data and our institutional experience during the crisis, we aimed to assess the safety of immediate device reconstruction following mastectomy to aid in decision-making during the pandemic.Methods:Women undergoing mastectomy only and mastectomy with immediate breast reconstruction (IBR) with tissue expander or permanent implant from the 2007–2013 ACS-NSQIP datasets were included. Multivariate analysis of independent variables was used to form propensity-matched cohorts. Incidence of 30-day major postoperative bleeding and hospital length of stay were compared.Results:In total, 13,580 mastectomy only patients and 11,636 IBR patients were identified. Factors that were found to be associated with IBR included age (P = 0.022), BMI (P < 0.001), race (P = 0.010), diabetes (P = 0.007), chronic steroid use (P = 0.003), pulmonary disease (P = 0.004), cardiovascular disease (P < 0.001), disseminated cancer (P = 0.001), chemotherapy before surgery (P = 0.016), low hematocrit (P < 0.001), and total operative time (P < 0.001). After propensity matching, immediate device reconstruction following mastectomy was not found to be associated with greater risk of postoperative bleeding (1.4% versus 1.0%, P = 0.334) or increased length of stay (1.5 ± 2.9 versus 1.5 ± 3.5 days, P = 0.576).Conclusions:Immediate device reconstruction does not elevate morbidity in terms of postoperative bleeding or does not increase the length of hospital exposure. Tissue expander or implant reconstruction can be safely performed immediately following mastectomy during the COVID-19 pandemic. Further, our institutional experience during the pandemic indicates that select patients can continue to safely undergo ambulatory mastectomy with device placement.

Perioperative Factor Concentrate Use is Associated With More Beneficial Outcomes and Reduced Complication Rates Compared With a Pure Blood Product–Based Strategy in Patients Undergoing Elective Cardiac Surgery: A Propensity Score–Matched Cohort Study

ObjectiveThe goal of this study was to compare factor concentrate (FC)–based and blood product–based hemostasis management of coagulopathy in cardiac surgical patients in terms of postoperative bleeding, required blood products, and outcome. DesignRetrospective, propensity score–matched analysis. SettingSingle, tertiary, academic medical center. ParticipantsOne hundred eighteen matched pairs of 433 consecutive patients scheduled for cardiac surgery in two isolated periods with distinct strategies of hemostasis management. InterventionsPatients received either blood product–based (period I) or FC-based (period II) hemostasis management to treat perioperative coagulopathy. Measurements and Main ResultsPatients treated with FC management experienced less postoperative blood loss (907 v 1,153 mL, p = 0.014) and required less red blood cell and fresh frozen plasma transfusion (2.3 v 3.7 units p < 0.0001, and 2.0 v 3.4 units p < 0.0001, respectively) compared with subjects in the blood product–based management group. The frequency of Stage 3 acute kidney injury and 30-day mortality rate were significantly higher in the blood product–based group than in the FC management group (6.8% v 0.8%, p = 0.016, and 7.2% v 0.8%, p = 0.022, respectively). FC management-related thromboembolic events were not registered. The FC strategy was associated with a 2.19-fold decrease in the odds of massive postoperative bleeding (p < 0.0001), a 2.56-fold decrease in the odds of polytransfusion (p < 0.0001), and a 13.16-fold decrease in the odds of early postoperative death (p = 0.003). ConclusionsFC-based versus blood product–based management is associated with reduced blood product needs and fewer complications, and was not linked to a higher frequency of thromboembolic events or a decrease in long-term survival in cardiac surgical patients developing perioperative coagulopathy and bleeding.

Comparison of different surgical treatment modalities for nasal obstruction caused by inferior turbinate hypertrophy

Background: Hypertrophied inferior turbinates considered the second most frequent contributor to nasal obstruction after septal defects. Various medical measures can be used to treat inferior turbinate hypertrophy (ITH). After failure of medical methods, surgery becomes the cornerstone of management, which is still a controversial issue in the otorhinolaryngology field. Although these surgeries have been practiced for decades, no conclusion has been drawn about the best and optimal choice. Objectives: The objectives were to compare the results between submucosal diathermy (SMD) and partial inferior turbinectomy (PIT) in terms of postoperative bleeding, crusting, dry throat, voice change, postnasal drip, nasal obstruction, need for re-use of medications, and further need for nasal surgery. Subjects and Methods: A prospective observational study involving 100 patients with ITH. Patients were randomly divided into two groups: Group A underwent SMD and Group B underwent PIT. Postoperative follow-up was done at 1 week, 1 month, and 6 months. Results: At 1-week, nasal crusting, postnasal drip, and dry throat were reported more in SMD. At 1-month, nasal crusting and voice change were experienced more in PIT. At 6-month, nasal crusting and voice change occurred more in PIT. Nasal obstruction occurred more in SMD. Re-use of medications and further nasal surgery were more in SMD. Conclusion: SMD is less invasive with fewer complications regarding bleeding and crusting in comparison to PIT, but its effectiveness compared to PIT in re-use of medications and need for further nasal surgery is less.

Bipolar loop device versus bipolar diathermy for tonsillectomy: A pilot randomized controlled trial

ObjectiveTonsillectomy is one of the most common surgeries performed in the pediatric population. Although different forms of instruments and various methods are used to perform tonsillectomy, none of them is still recognized as the best global technique. This study aimed to compare the outcomes of the new Bipolar Loop tonsillectomy versus bipolar diathermy technique. MethodsThis study is a pilot randomized clinical trial and was conducted on 40 pediatric patients who were the candidate of tonsillectomy. Patients were divided into two groups of Bipolar Loop or bipolar diathermy. Operation time, intraoperative bleeding, tonsillar fossa wound, postoperative complications, and duration of return to normal diet were evaluated in the current study. ResultsIn both of the Bipolar Loop and bipolar diathermy groups, no significant difference was found in terms of sex, age, and weight. The average amount of the operative time, intra-operative blood loss, and postoperative pain loss were significantly less in the Bipolar Loop group (P < .001). In addition, the tonsillar fossa wound healing scores were significantly better (on the 14th day, P = 0.009). However, there was no significant difference between the two groups in terms of postoperative bleeding, duration of return to a normal diet, and postoperative symptoms of fever, otalgia, or voice change between the groups. ConclusionThe study showed that blood loss and postoperative pain through day 7 were significantly less in the Bipolar Loop group. Tonsillectomy with Bipolar Loop can be recommended as one of the methods for tonsillectomy, especially in pediatric patients.

The effect of applying amniotic membrane on post-tonsillectomy pain and bleeding.

Pain and hemorrhage are common morbidities after tonsillectomy. Although many studies have focused on post-tonsillectomy pain, inadequate researches are available on wound healing. Hence, there is a definite need for a novel technique to facilitate the healing process and thereby improving the post-tonsillectomy recovery. This prospective and randomized study was conducted on 60 adult patients who underwent tonsillectomy. They were divided into two groups of control and amniotic membrane (AM). Human amniotic membrane was applied over the tonsillar bed as a biologic dressing. Post-tonsillectomy pain and bleeding were evaluated. Also, the healing rate was assessed on days 5, 10 and 15 post-operatively. The pain score in the AM group was lower than that in the control group during the first week after surgery (P < 0.0001). Moreover, the AM group returned faster to their normal diet in comparison with the control group (P < 0.0001). With respect to the healing rate, there were no significant differences between the groups on day 5 (P > 0.05), whereas a significant difference was seen on days 10 and 15 post-surgery (P < 0.0001). There was no significant difference between the two groups in terms of post-operative bleeding (P ≅ 1). We observed that the use of AM graft as a biologic dressing might be beneficial in reducing post-operative pain and promoting the wound healing process. The results represent a further step toward developing a new technique for coverage of tonsillar fossa with sheeting or wearing grafts.

Comparison of bipolar cautery dissection and harmonic scalpel tonsillectomy in terms of postoperative bleeding and pain in children

Aim: To compare postoperative bleeding and pain in children after tonsillectomy with bipolar diathermy versus tonsillectomy with harmonic scalpel tonsillectomy.Materias and Methods: Group A, 25 patients were treated by tonsillectomy with bipolar diathermy and group B, 25 patients underwent tonsillectomy with harmonic scalpel. Results: Postoperative bleeding occurred in one patient in each group. The mean pain postoperative first day was 8.51±1.31 in the bipolar tonsillectomy group (BTG) and 6.02±0.84 in the harmonic scalpel group (HSG), 3th day 6.84±1.42 in the BTG and 4.98±1.03 in the HSG and at the postoperative 5th day were examined, it was 5.39±0.73 in the BTG and 3.95±0.74 in the HSG and this differences were significant statistically (p&amp;lt;0.05).Conclusion: Harmonic scalpel tonsillectomy technique is significantly less painful in postoperative early period compared to bipolar cautery technique.

Comparison of Early-period Results of Nasal Splint and Merocel Nasal Packs in Septoplasty.

Several types of nasal packs are used postoperatively in septoplasty. In this study, we compared two commonly used nasal packing materials, the intranasal septal splint with airway and Merocel tampon, in terms of pain, bleeding, nasal obstruction, eating difficulties, discomfort in sleep, and pain and bleeding during removal of packing in the early period. The study group included 60 patients undergoing septoplasty. Patients were divided into two groups (n=30 in each group). An intranasal splint with airway was used for the patients in the first group after septoplasty, while Merocel nasal packing was used for the second group. Patients were investigated in terms of seven different factors - pain, bleeding while the tampon was in place, nasal obstruction, eating difficulties, night sleep, pain during removal of the nasal packing, and bleeding after removal of packing. There was no statistically significant difference between the groups in terms of pain 24 hours after operation (p=0.05), while visual analog scale (VAS) scores for nasal obstruction, night sleep, eating difficulties, and pain during packing removal were lower in the nasal splint group with a statistically significant difference (p<0.05). There was no statistically significant difference between the groups in terms of postoperative bleeding (p=0.23). Significantly less bleeding occurred during removal of the packing in the nasal splint group (p<0.05). Our study indicates that the nasal splint was more comfortable and effective in terms of causing lesser bleeding and pain during removal of packing.

Early or late fresh frozen plasma administration in newborns and small infants undergoing cardiac surgery: the APPEAR randomized trial

BackgroundIn newborns and small infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) and blood priming, it is unclear whether there is reduced blood loss if fresh frozen plasma (FFP) is added to the CPB priming volume. This single-centre, randomized trial tested the hypothesis that the administration of FFP after CPB (late FFP group) is superior to FFP priming (early FFP group) in terms of postoperative bleeding and overall red blood cell (RBC) transfusion. MethodsSeventy-three infants weighing <10 kg were randomly allocated to receive FFP to supplement RBCs in the CPB priming solution (n=36) or immediately after CPB (n=37). The primary endpoint was a difference in postoperative blood loss; secondary endpoints included the amount of RBCs and FFP transfused through the first 48 postoperative hours. ResultsAll patients were included in the analysis. Patients in the late FFP arm had greater postoperative mean blood loss than patients in the early FFP arm [33.1 (sd 20.6) vs 24.1 (12.9) ml kg−1; P=0.028], but no differences in transfusions were found. The subgroup of cyanotic heart disease patients had comparable results, but with greater use of RBCs in the late FFP group. ConclusionsIn infants undergoing cardiac surgery, FFP in the priming solution appears slightly superior to late administration in terms of postoperative bleeding. Clinical trial registration:www.ClinicalTrials.gov, NCT02738190.

Comparison of Endoscopic and External Dacryocystorhinostomy Results and Analysis of Patients' Satisfaction.

Comparison of endoscopic and external dacryocystorhinostomy (DCR) results and evaluation of patients' satisfaction. Forty six (35 females and 11 males) patients who underwent endoscopic DCR and 43 (37 females and six males) who underwent external DCR were included. Surgical success was objectively and subjectively assessed. The nasolacrimal duct was irrigated by a saline solution, and the saline solution was objectively visualized by endoscopy from the nose. Subjective assessment was performed asking the patients' epiphora. In addition to evaluating the success of the operation, satisfaction and result surveys were administered to the two groups. There was no statistically significant difference between the two groups in terms of age and sex (respectively p=0.486, p=0.23). However, the number of females was higher than the number of males in the two groups, and the difference was statistically significant (endoscopic-DCR p=0.01, external-DCR p=0.001). There was no statistically significant difference between the two groups in terms of postoperative bleeding and punctum damage. The success rate was 84.7% in the endoscopic DCR group and 90.6% in the external DCR group. There was no statistically significant difference in the success rate between the two groups (p=0.397). The survey results revealed that there was no statistically significant difference between the two groups in terms of patient satisfaction (p=0.397). The results of many studies in the literature show operation success rates between the two groups that are similar to ours. Both techniques have advantages and disadvantages. Independent of the preferred procedure, our results show that functional success mainly determines patient satisfaction.

Effect of Desmopressin in Reducing Bleeding after Cardiac Surgery in Patients Receiving Anti-Platelet Agents

Background : Severe bleeding is an important cause of morbidity and mortality in cardiac surgery using the cardiopulmonary bypass (CPB) pump. Desmopressin, a synthetic analogue of vasopressin, is used to prevent postoperative bleeding in patients with renal insufficiency. The aim of the present study was to evaluate the effect of desmopressin in reducing blood loss after cardiac surgery in patients receiving antiplatelet drugs. Methods: In this prospective clinical trial, 40 patients undergoing coronary artery bypass grafting (CABG) surgery with CPB, aged over 18 years, and on antiplatelet therapy for a week before surgery were divided in two groups. Case and control groups received nasal desmopressin spray and nasal normal saline spray, respectively. Patient vital signs, blood loss, administration of blood products, prescription drugs to improve the coagulation status, serum and whole intake and output of patients, need for a second surgery to control the bleeding, remaining sternum open, mortality due to bleeding, duration of intensive care unit (ICU) stay and mechanical ventilation were recorded. Results: In the case and control groups there were no differences in duration of operation, mechanical ventilation and length of ICU stay. There was no significant difference in terms of postoperative bleeding and intake of blood products between two groups ( P &gt;0.05). Reoperation due to bleeding in the case and control groups was observed in 3 (15%), and 1 (5%) patient(s), respectively ( P =0.3). Conclusion: Desmopressin has no significant effect on reducing the amount of bleeding after cardiac surgery in patients receiving anti-platelet agents. Keywords: CABG; cardio pulmonary bypass pump; hemorrhage; desmopressin

The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection

ObjectiveAlthough tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection. MethodsThis double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study. ResultsIn both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001).patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups.Moreover, Compared pain scores in all times across two groups, no significant difference was found.In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up. ConclusionOur study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children.

The effects of a cold pack on postoperative turbinate and/or septal bleeding and pain.

The objective of this study is to evaluate the effects of a cold pack in postoperative turbinate and/or septal surgery in terms of postoperative bleeding control, pain management, and patient preference for or against application of a cold pack. A randomized controlled trial was done at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Ninety-nine adult subjects intending to have turbinate and/or septal surgery were consecutively enrolled in this study. Intervention was randomized into two groups. Postoperative bleeding was collected by paper tissue and weighed to determine amount and/or volume of blood loss. Postoperative pain was measured by using the visual analog scale. Patient preference for or against the use of a cold pack was also assessed. The mean (standard deviation) postoperative bleeding in the cold pack group was 1.31 ± 1.50 g compared with 1.81 ± 1.89 g in the control group. The mean difference was 0.50 g (95% confidence interval, -0.19 to 1.19 g; p = 0.15). The mean (standard deviation) postoperative visual analog scale pain score in the cold pack group was 2.40 ± 2.32 compared with 3.33 ± 2.83 in the control group. The mean difference was 0.94 (95% confidence interval, -0.11 to 1.99; p = 0.79). Most of the subjects preferred using a cold pack (78.7%) to not using a cold pack (21.3%) (p < 0.001). A cold pack after turbinate and/or septal surgery had no benefit in terms of postoperative bleeding or postoperative pain.

Powered intracapsular tonsillotomy vs. conventional extracapsular tonsillectomy for pediatric OSA: A retrospective study about efficacy, complications and quality of life

ObjectivesTo compare the results of powered intracapsular tonsillectomy and adenoidectomy (PITA) with that of conventional extracapsular tonsillectomy and adenoidectomy (ECTA) in treatment of pediatric obstructive sleep apnea (OSA) as regard efficacy, complications including postoperative pain and bleeding, and quality of life. MethodsFour hundred fifty children with adenotonsillar hyperplasia (with age range from 3 to 14 years) underwent tonsillectomy±adenoidectomy (251 PITA and 199 ECTA) from January 2012 till October 2014 for OSA. Outcome measures included Obstructive Sleep Apnea Survey (OSA-18), the number of cases treated for post tonsillectomy bleeding with particular regard to the number of cases that needed readmission, the need for analgesics, the visual analog scale (VAS) for post-operative pain, the perceived satisfaction assessed by post tonsillectomy quality of life questionnaire (QOL). ResultsOSA-18 scores proved that both PITA and ECTA were equally effective in curing upper airway obstructive symptoms as reflected by the targeted questionnaire. Postoperative bleeding was significantly lower in the PITA group (P<0.01). Postoperative pain and number of needed analgesic doses were significantly lower in the PITA group (P=0.01, P<0.01, respectively). Satisfaction and quality of life were significantly higher in the PITA group (P<0.01). ConclusionPITA is proved to be effective in treating pediatric OSA with less morbidity, less complications in terms of postoperative bleeding mainly with better satisfaction and lower incidence of regrowth.

English

PURPOSE OF STUDY: Nasal dressing following nasal surgery in an attempt to prevent postoperative bleeding and to modulate the wound healing process. Experience with postoperative nasal dressings in otolaryngologic literature spans more than half a century; despite of this, there is still little agreement between the surgeons on the appropriate choice of nasal dressings following nasal surgery, or whether nasal dressings are required at all. This paper briefly reviews the comparative study between the postoperative cases with and without nasal dressings. STUDY DESIGN: It is a prospective study carried out in a tertiary care, teaching hospital. MATERIALS AND METHODS: A prospective evaluation of patients who underwent nasal surgery at tertiary teaching hospital setting between February 2013 to June 2014 was performed. Nasal dressing was done in some cases who underwent nasal surgery and no dressing was done in some cases. The comparative results between the cases with and without nasal packing in terms of Postoperative bleeding, Adhesion formation, Middle turbinate lateralization were studied. RESULTS: Out of 160 patients included in this study, nasal dressing postoperatively was done in 92 cases and 68 cases were not packed postoperatively. In terms of postoperative bleeding there is no significant difference between the cases with packs (5.43%) and without pack (5.88%). Postoperative Adhesion formation was less in cases without nasal packing (2.94%) than in cases with nasal dressing (8.7%). Middle turbinate lateralization is also less in cases without nasal packing (8.82%) than in cases with nasal packing (17.5%). CONCLUSION: The decision as to whether to pack the nose after nasal surgery remains controversial. There has been an increasing tendency to move away from removable nasal dressings due to discomfort and bleeding upon removal and also postoperative adhesions. This study showcases that there is no considerable difference in postoperative bleeding in patients with or without nasal dressings postoperatively. It also shows that wound healing is better and middle turbinate lateralization is less significant in cases without nasal packings than in cases with post- operative nasal dressings.

Postoperative Bleeding after CABG - does Individualized Heparin Management Save Blood?

Objectives: To compare routine activated clotting time (ACT) based hemostasis management to individualized heparin management (IHM) in terms of postoperative bleeding, platelet function, and coagulation markers.