Immediate and delayed complications of adenotonsillectomy
Keywords:Adenotonsillectomy, Complications, Conventional tonsillectomy, Coablation tonsillectomy
Background: Tonsillectomy with or without adenoidectomy is the commonest pediatric otorhinolaryngological procedure. The aim of the present study was to compare the intraoperative (immediate) and postoperative (delayed) complications between in conventional and coablation tonsillectomy in children.
Methods: This observational study was conducted among 100 children between 5 and 15 years who had conventional tonsillectomy and 50 children who had coblation tonsillectomy. Intraoperative and postoperative complications were observed and compared between two groups.
Results: Of the total 150 children, 64 (42.7%) were males and 86 (57.3%) were females with mean age of 9.42±2.67 years. Common preoperative symptoms were odynophagia (96.0%), throat pain (95.3%) and difficult swallowing (89.3%). Among the intraoperative anesthetic complications, compression of endotracheal tube was observed in 19 (12.7%), accidental extubation in 10 (6.7%) and dislodging of loose tooth in 9 (6.0%) patients. Regarding intraoperative surgical complications, primary hemorrhage was seen in 43 (28.7%), edema uvula in 39 (26.0%) and pillar injury in 33 (22.0%) patients. Commonest postoperative complication was oropharyngeal pain (18.7%) followed by primary hemorrhage (14.0%) and nausea, vomiting (13.3%). Immediate complications like primary haemorrhage (p value 0.0001) and uvula edema (p value 0.018) were significantly associated with conventional tonsillectomy group while delayed complications like secondary haemorrhage (p value 0.011) and referred otalgia (p value 0.0001) were with coblation tonsillectomy group.
Conclusions: Compression of endotracheal tube and primary hemorrhage were the commonest intraoperative anesthetic and surgical complication respectively. Immediate complications were significantly associated with conventional tonsillectomy group while delayed complications were with coblation tonsillectomies.
Kenna MA, Amin A. Anatomy and physiology of the oral cavity. In: Snow JB, Wackym PA. Ballenger's Otorhinolaryngology Head and Neck Surgery. 17th edition. Shelton: BC Decker Inc; 2009: 769-774.
Hellings P, Jorrissen M, Ceuppens JL. The Waldeyers ring. Acta Otorhinolaryngologica Belgica. 2000;54:237-41.
Falagas ME, Vouloumanou EK, Matthaiou DK, Kapaskelis AM, Karageorgopoulos DE. Effectiveness and safety of short-course vs long-course antibiotic therapy for group A -hemolytic streptococcal tonsillopharyngitis: ameta-analysis of randomized trials. Mayo Clin Proc. 2008;83(8):880-9.
Stjernquist- Destnik A, Preneller K, Schalen C. High recovery of haemophilus influenza and group A streptococci in recurrent tonsillar infection and hypertrophy as compared with normal tonsils. J Laryngol Otol. 199;105:439-41.
Polvogt LM, Crowe SJ. Predominating organisms found in cultures from tonsils and adenoid. J Am Med Association 1929;92:962-4.
Toner J, Stewart G, Campbell TB, Hunter JB. Tonsil flora in the very young tonsillectomy patient. Clin Otolaryngol. 1986;11:171-4.
Ali A, Nisar J, Ali I, Ahmad R. Study of impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB. Int J Otorhinolaryngol Head Neck Surg. 2018;4:448-54.
Subramaniam V, Pai V, Mazumdar MR. Effects of adenotonsillectomy on humoral immunity. Int J Otorhinolaryngol Head Neck Surg. 2016;2:230-3.
Berkovitz BKB, Holland GR, Moxham BJ. Oral anatomy, histology and embryology. 3rd edition. London: Mosby; 2002.
Júnior JFN, Hermann DR, Américo RR, Stamm RG, Hirata CW. A brief history of tonsillectomy. Int. Arch. Otorhinolaryngol. 2006;10(4):314-7.
Blanchford H, Lowe D. Cold versus hot tonsillectomy: state of the art and recommendations. ORL 2013;75:136-41.
Nithya V, Dutta A, Sabarigirish K. A comparative study of coblation assissted adenotonsillectomy and cold dissection adenotonsillectomy in children. Int J Otorhinolaryngol Head Neck Surg. 2017;3:122-7.
Davis DD. Reanaesthetizing cases of Tonsillectomy and adenoidectomy because of persistent post operative haemorrhage. Br J Anaes. 1964;36:244–9.
Liu JH, Anderson KE, Willging JP, Myer CM, Shott SR, Bratcher GO, et al. Post tonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg. 2001;127(10):1271–5.
Linden BE, Gross CW, Long TE, Lazar RH. Morbidity in pediatric tonsillectomy. Laryngoscope. 1990;100:120-4.
Schmidt R, Herzog A, Cook S, O’Reilly R, Deutsch E, Reilly J. Complications of tonsillectomy: a comparison of techniques. Arch Otolaryngol Head Neck Surg. 2007;133(9):925–8.
Shah UK, Galinkin J, Chiavacci R, Briggs M. Tonsillectomy by means of plasma-mediated ablation: prospective, randomized, blinded comparison with monopolar electrosurgery. Arch Otolaryngol Head Neck Surg. 2002;128(6):672–6.