An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 15 , ISSUE 3 ( September-December, 2023 ) > List of Articles

Original Article

A Comparative Study between Lower Pole Silk Ligation and Pillar Suturing Technique of Hemostasis in Tonsillectomy

Balaji Shankarrao Mane, Rushali Madhukar Gavali

Keywords : Cold dissection, Hemostasis, Lower pole, Pillar suturing, Post-tonsillectomy bleed, Silk ligation

Citation Information : Mane BS, Gavali RM. A Comparative Study between Lower Pole Silk Ligation and Pillar Suturing Technique of Hemostasis in Tonsillectomy. Int J Otorhinolaryngol Clin 2023; 15 (3):103-106.

DOI: 10.5005/jp-journals-10003-1453

License: CC BY-NC 4.0

Published Online: 09-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: Tonsillectomy operation was first described in the literature in 1000 BC by Celsus and Paul of Aegine. Various attempts have been made till now in the literature to control bleeding, including injection of medicines into peritonsillar area, fibrin glue application to the surgical site, suturing together the pillars, lower pole silk ligation. The aim of this study was to compare the morbidity associated with tonsillectomy using two different methods of hemostasis. Materials and methods: The study design was duration-based prospective observational study which was conducted at the ENT Department of our Institute from August 2021 to August 2022. Total of 200 patients who have undergone tonsillectomy during this 1-year duration were selected for the study. In half number of patients, pillar suturing technique was performed, and in the remaining half number of patients, lower pole silk ligation was used to control bleeding during operation to compare the morbidity associated with each technique. Results: Pillar suturing technique shown statistically significant reduction in primary and secondary post-tonsillectomy hemorrhage as compared to lower pole silk ligation. Conclusion: Tonsillectomy procedure with pillar suturing technique of hemostasis has shown earlier pain relief and significantly faster wound healing than lower pole silk ligation technique. Pillar suturing technique of hemostasis has shown significantly increased pillar edema without significant increase in palatal discomfort sensation, palatal hematoma, suture site infection as compared with lower pole silk ligation technique of hemostasis. However, pillar suturing technique of hemostasis has shown similar results as that of lower pole silk ligation technique in terms of velopharyngeal insufficiency.


PDF Share
  1. Bicknell PG. Role of adeno-tonsillectomy in the management of paediatrics ear nose and throat infection. Paediac Infect Dis J 1994; 13:575–578. DOI: 10.1097/00006454-199401001-00016.
  2. Kaerns BD, Pransky SM, Seid AB. Current concepts in paediatric adeno-tonsillar disease. Net J 1991;17:15–20. PMID: 2065614.
  3. Curtain MA. The history of tonsils and adenoids otolaryngologic clinic of north america 1987;20:60–62. DOI: https://doi.org/10.1016/s0030-6665(20)30509-0.
  4. Murty GE, Watson MG. Diathermy haemostasis at tonsillectomy: Current practice. J Larygo Otol 1990;104:549–552. DOI: 10.1017/S0022215100113131.
  5. Hommer JJ, William BT, Semple P, et al. Tonsillectomy by guillotone is less painful than by dissection. Int J Paed Otorhinolarygol 2000; 52(1):25–29. DOI: 10.1016/S0165-5876(99)00296-7.
  6. Zwack GC, Derkay CS. The utility of preoperative haemostasis assessment in adeno-tonsil-Lectomy. Int J Ped Otolaryngology 1997;39(1):67–76. DOI: 10.1016/S0165-5876(96)01465-6.
  7. Wiatrak BJ, Willging JP. Harmonic scalpel for tonsillectomy. Laryngoscope 2002;112 (suppl 100):14–16. DOI: 10.1002/lary.55411 21406.
  8. Koempal JA. On the origin of tonsillectomy and the dissection method. Laryngoscope 2002;112:1583–1586. DOI: 10.1097/00005537-200209000-00009.
  9. Ayatollahi V, Behdad S, Hatami M, et al. Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: A double-blinded randomized placebo-controlled clinical trial. Croat Med J 2012;53:155–161. DOI: 10.3325/cmj.2012.53.155.
  10. Vaiman M, Eviatar E, Shlamkovich N, et al. Effect of modern fibrin glue on bleeding after tonsillectomy and adenoidectomy. Ann Otol Rhinol Laryngol 2003;112(5):410–414. DOI: 10.1177/000348940311200504.
  11. Akural EI, Alahuhta S, Ohtonen P, et al. Peritonsillar morphine infiltration to prevent early postoperative pain after tonsillectomy: A randomised controlled trial. Eur J Anaesthe-Siol 2016;33(8):607–609. DOI: 10.1097/EJA.0000000000000402.
  12. Nandapalan V, McIlwain JC. Tonsillar fossa obliteration and post-operative pain. Clin Otolaryngol Allied Sci 1995;20:127–129. DOI: 10.1111/j.1365-2273.1995.tb00028.x.
  13. Carmody D, Vamadeva T, Cooper SM. Post tonsillectomy haemorrhage. J Laryngol Otol 1982;88:117–121. DOI: 10.1017/S0022215100092926.
  14. Genc E, Hanci D, Ergin NT, et al. Can mucosal sealing reduce tonsillectomy pain? Int J Pediatr Otorhinolaryngol 2006;70(4): 725–730. DOI: 10.1016/j.ijporl.2005.12.005.
  15. Tawfik A, Elkholy T. Modified surgical technique with pillars repair in Reducing post tonsillectomy haemorrhage. Int Inv J Med Med Sci 2016;3:108–114. Available from: http://internationalinventjournals.org/journals/IIJMMS.
  16. Baugh RF, Archer SM, Mitchell RB, et al. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Clinical Practice Guideline: Tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144(1 suppl):S23. DOI: 10.1177/0194599810389949.
  17. Mann DG, George CSt., Scheiner D, et al. Tonsillectomy, some like it not. Laryngoscope 1984;94:677–679. DOI: 10.1288/00005537-1984 05000-00019.
  18. Gross CW, Gallagher R, Schlosser RJ, et al. Autologous fibrin sealant reduces pain after tonsillectomy. Laryngoscope 2001;111:259–263. DOI: 10.1097/00005537-200102000-00014.
  19. Sclafani AP, Jacono AA, Dolitsky JN. Grafting of the peritonsillar fossa with an acellular dermal graft to reduce posttonsillectomy pain. Am J Otolaryngol 2001;22:409–414. DOI: 10.1053/ajot.2001.28077.
  20. Shu Y, Yao HB, Yang DZ, et al. Postoperative characteristics of combined pharyngoplasty and tonsillectomy versus tonsillectomy in children with obstructive sleep apnea syndrome. Arch Argent Pediatr 2018;116:316–321. DOI: 10.5546/aap.2018.eng.316.
  21. Hu TL, Yun C, Wang R, et al. Management of velopharyngeal insufficiency in the presence of enlarged tonsils: Comparing a one-stage versus two-stage treatment result. J Plast Reconstr Aesthet Surg 2008;61:883–888. DOI: 10.1016/j.bjps.2007.05.003.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.