مقايسه موربيديتي تونسيكلتومي به روش قيچي الكتروكوتر دوقطبي با روش كلاسيك

Post Tonsillectomy Morbidities:Bipolar Electrosurgical Scissor Vs Classic Method

Introduction. Tonsillectomy performed by a variety of techniques such as laser bipolor and monopolar electrodissetion and blunt dissection (classic method). Serious and lethal post operative complications secondary to tonsillectomy are related to bleeding and anesthesia. For this reason we have introduced a modified form of electrodissection tonsillectomy using bipolor scissor diathermy to compare the morbidities with classic method. Methods. One hundered patients (2 to 30 years old) candidate for tonsillectomy, were entered in a randomized controlled clinical trial to compare the post tonsillectomy morbidities. Fifty patients were operated with bipolar electrosurgical scissor and fifty patients with classic method. This study was performed in Kashani and Alzahra medical centers of Isfahan university. Patients with a positive history of bleeding tendency and tonsillectomy performed because of tonsillar cancer or uppp (uvulopalato pharyngoplasty) were excluded. Results. Bipolar electrosurgical scissor tonsillectomy significantly reduce intraoperative bleeding (3.1-74.5 mL) in comparison to classic method (70±30.61 mL) (P<0.001). No bleeding occurs in 24 hours and 10 day after operation in both methods. Mean of pain intensity in both methods, was similar. Mean time of ability for fluid Swallowing after bipolar method was lesser than classic method (3/4±1/47 h VS 4 ± 1/69 h) (P>0.05). Bipolar tonsillectomy significantly reduces the time of operation and anesthesia (7.3±2.76 min VS 11.5±3.29 min) (P<0.001). Only 4 percent of electrodissection group and 70 percent of classic group was required to suturing in tonsillar bed (P<0.001). Delayed otalgia in electrosurgical group was greater than classic group. Discussion. The most common cause of death in tonsillectomy is bleeding and anesthetic complication. We believe the bipolar electrosurgical tonsillectomy result in significantly reduce intraoperative blood loss and time of operation and lesser need to sutring of tonsillar bed. Thus if we can reduce the post operative otalgia in electrodissection method, this method will be the best technique of tonsillectomy in future.