Tonsillectomy Using Intracapsular Technique Associated With Reduced Postoperative Pain And Bleeding

An intracapsular technique of tonsillectomy seems to offer less postoperative heavy bleeding and pain for patients, compared to traditional tonsil removal surgery, says a report in Archives of Otolaryngology-Head & Neck Surgery (JAMA/Archives), September issue. With the intracapsular technique 90% or more of the tonsil tissue is removed, but not the tonsil capsule.

The authors explain that tonsillectomy is one of the most commonly performed surgeries in the USA, with or without removal of the adenoids. “The technique for performing tonsillectomy, dissection of all tonsillar tissue free of the underlying pharyngeal constrictor muscle, has not changed significantly in more than 60 years. The most common serious complication of tonsillectomy is delayed hemorrhage [severe bleeding], which occurs in 2 percent to 4 percent of all patients. In addition, an expected sequela (consequence) of the procedure is pain, which typically lasts from seven to 10 days and can be moderate to severe in intensity,” they add.

Richard Schmidt, M.D., Alfred I. duPont Hospital for Children, Wilmington, Del., and team looked at the medical records of 2,944 patients – they all had their tonsils removed (tonsillectomy) with or without adenoidectomy (adenoids taken out) during the period 2002-2005. 1,731 of them underwent a intracapsular tonsillectomy, a newer technique. With intracapsular tonsillectomy at least 90% of the tonsil tissue is taken out, preserving the capsule (a layer of tonsil over the throat muscles. The rest underwent traditional tonsillectomy, during which all the tonsil tissue is removed.

The researchers found out the following:

Traditional tonsillectomy group
— 3.4% had delayed hemorrhage
— 2.1% required treatment in the operating room for bleeding
— 5.4% required emergency room treatment for pain or dehydration
— 0% needed revision tonsillectomies

Intracapsular tonsillectomy group
— 1.1% had delayed hemorrhage
— 0.5% required treatment in the operating room for bleeding
— 3% required emergency room treatment for pain or dehydration
— 0.64% needed revision tonsillectomies

The authors write “The ideal tonsillectomy would have minimal or no risks and be completely effective. Although the risks for intracapsular tonsillectomy are lower than those for traditional tonsillectomy, the procedure is not always effective. Eleven patients required revision tonsillectomy in the intracapsular tonsillectomy group compared with none in the traditional tonsillectomy group. However, an additional surgical procedure (including control of hemorrhage in the operating room) may be more likely with traditional tonsillectomy than with intracapsular tonsillectomy.”

Arch Otolaryngol Head Neck Surg. 2007;133(9):925-928
http://archotol.ama-assn.org

Written by: Christian Nordqvist

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