Post-tonsillectomy hemorrhage. Monopolar microdissection needle versus cold dissection

OBJECTIVE: To compare the rate, severity, need for intervention, and blood transfusion requirement in post-tonsillectomy bleeding following the use of either cold dissection or the monopolar microdissection needle method.

METHODS: A prospective randomized study conducted at Abha Private Hospital, Abha, Kingdom of Saudi Arabia, on patients undergoing tonsillectomy between June 2006 and December 2010. Patients were allocated randomly by using cold dissection or monopolar microdissection techniques. Collected information included demographic data, method, duration of surgery, and estimated blood loss. Timing of bleeding and management were recorded.

RESULTS: A total of 1419 patients underwent tonsillectomy, 634 male and 785 female with mean age of 14.8 years (range 2-48 years). Cold dissection was used in 674 patients and monopolar microdissection needle in 745 patients. Mean surgical time in the cold dissection group was 7 minutes (range 3.5-15 minutes), while in the monopolar microdissection group was 3.2 minutes (range 2.2-9.5 minutes). Twenty-seven patients developed post-tonsillectomy bleeding (rate of 1.9%); 21 (3.1%) from the cold dissection and 6 (0.8%) from the monopolar microdissection group, (p<0.001). All patients were hospitalized. Eleven patients; 9 from the cold dissection group and 2 following monopolar microdissection, underwent surgical intervention to stop bleeding. No patient received blood transfusion.

CONCLUSION: Patients underwent tonsillectomy using the monopolar microdissection (Colorado needle) had statistically significant less post-tonsillectomy bleeding rate and severity compared with those using the cold dissection method.