Local application of haemocoagulase for control of haemorrhages after tonsillectomy: a study in a teaching hospital


  • Harikrishna Kishore Department of ENT, Vishwabharathi Medical College, R.T. Nagar, Kurnool, Andhra Pradesh, India




Tonsillectomy, Post-operative bleeding, Haemocoagulase, Local application


Background: Post-tonsillectomy haemorrhage remains the most serious complication of tonsillectomy. Many topical agents have been used to control the post-operative bleeding by the surgeons. This study was undertaken to evaluate hemocoagulase as a local application in tonsillectomy for the control of primary, reactionary and secondary haemorrhages.

Methods: 50 patients, between the ages 5-60 years, who came with chronic tonsillitis or adenoid hypertrophy, were included into the study. The surgery was performed under general anaesthesia by tonsillar resection or tonsilloadenoid resection.  

Results: The most common age group to be affected was between 5 and 15 years, though in this age group the number of females and males were the same, accounting for 28% each of the total number of patients. Among the 50 patients, only 5 (10%) of them had reactionary haemorrhage, which was immediately contained. None of the patients had either primary or secondary haemorrhage.

Conclusions: The use of hemocoagulase has after tonsillectomy has definite advantage in controlling post-operative bleeding. It can be used as a routine application after tonsillectomy to control the bleeding.


Moonka PK, Ligation verses bipolar diathermy for homeostasis in tonsillectomy. Ind J Otolaryngeol Head Neck Surg. 2002;54(1):35-8.

Karatzanis A, Bourolias C, Prokopakis E. Thermal welding technology vs ligature tonsillectomy: a comparative study. Am J Otolaryngol. 2008;29(4):238-41.

Ahsan F, Rashid H, Eng C. Is secondary hemorrhage after tonsillectomy in adults an infective condition? objective measures of infection in a prospective cohort. Clin Otolaryngol. 2007;32(1):24-7.

Evans AS, Khan AM, Young D. Assessment of secondary hemorrhage rates fallowing adult tonsillectomy-a telephone survey and literature review. Clin Otolaryngol Allied Sci. 2003;28(6):489-91.

Agostino DR, Taro V, Calevo MG. Post-tonsillectomy late hemorrhage: is it a preferably night-time event? Int J Pediatr Otorhinolaryngol. 2009;73(5):713-6.

Wieland A, Belden L, Cunningham M. Preoperative coagulation screening for adenotonsillectomy: a review and comparison of current physician practices. Otolaryng Head Neck Surg. 2009;140(4):542-7.

Windfuhr JP, Schloendorff G, Baburi D, Kremer B. Life-threatening post tonsillectomy hemorrhage. Laryngoscope. 2008;118(8):1389-94.

Chang HJ, Beek SH, Choi CY, Kang SN, Park JB, Lee WY, Kim CA. Haemostatic efficacy of topical application of cold hydrogen peroxide in adenoidectomy. Koean J Otolaryngol Head Neck Surg. 2003;46:946-9.

Ahmed MA, Abbasi L, Zahna K Saeed. Hydrogen Peroxide 3%: Is it Beneficial in Tonsillectomy? Sultan Qaboob University Med J. 2006;8:2001-4.

Fenton JE, Blayney AW, Dwyer TP. Bismuth sulohate- its role in tonsillectomy. J Laryngol Otol. 1995;109:203-5.

Roy A, Dela Rosa C, Veechi YA. Bleeding following tonsillectomy. A study of electrocoagulation and ligation techniques. Arch Otolaryngol. 1976;102:9-10.

Mosges R, Hellmich M, Allekotte S, Albrecht K, Bohm M. Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. Eur Arch Otorhinolaryngol. 2011;268(6):807-16.

Parmar B, Mansuri S, Garg K, Solanki D. Efficacy of haemocoagulase a topical hemostatic agent after 3rd molar surgery. J Maxillofac Oral Surg. 2006;5:5-9.

Shi Y, Zhao J, Tang S, Pan F, Liu L, Tian Z, et al. Effect of haemocoagulase for prevention of pulmonary hemorrhage in critical new borns on mechanical ventilation: a randomized controlled trial. Indian Pediatr. 2008;45:199-202.

Belasy FA, Amer MZ. Heomostatic effect of n-butyl-2-cyanoacrylate (histoacryl) glue in warfarin-treated patients undergoing oral surgery. J Oral Maxillofac Surg. 2003;61:1405-9.

Palmisano PA. Klobusitsky's haemocoagulase in plastic surgery. Minerva Chir. 1975;30:686-92.

Joshi SA, Gadre KS, Halli R, Shandilya R. Topical use of hemocoagulase (reptilase): a simple and effective way of managing post-extraction bleeding. Ann Maxillofac Surg. 2014;4(1):119.

Callann V, Curren AJ, Smythe DA, Gormley PK. The influence of bismuth subgallate and adrenalin paste upon operating time an operative blood loss in tonsillectomy. J Laryngol Otol. 1995;109:206-8.

Agarwal SR, Jain AK, Marathe D, Agarwal R. The use of bismuth subgallate as haemostatic agent in tonsillectomy. Ind J Otol. 2005;57:287-9.

Coolision PJ, Mettler B. Factor associated with post tonsillectomy. Ear Nose Throat J. 2000;79:640-2.

Bleeding after tonsillectomy cause analysis and prevention of treatment. Available at http:// eng. hi138. com/ medicine-papers/ medical-papers /200812/121567_bleeding-after-tonsillectomy-cause- analysis- and- prevention- of-treatment. Asp #.V9jz_U196M8. Accessed on 12 January 2016.

Bhattacharya N. Evaluation of post-tonsillectomy bleeding in the adult population. Ear Nose Throat. 2001;80(8):544-9.

Papngelou I. Hemostatasis in tonsillectomy a comparison of electrocoagulation and ligation. Oto Head Neck Surg.1972;96:358-60.

Mallik MK, Bhatia BP, Kumar R. Control of hemorrhage in tonsillectomy. Clin Otolaryngol. 1982;14:419-24.

Watson MG, Cawes PJ, Sameul PR, Marshall HF, Rayappa C, Hill J, et al. A study of haemostasis following tonsillectomy comparing ligatures with diathermy. J Laryngol Otol. 1993;107(8):711-5.

Schmidt H, Schmiz A, Stasche N, Hormann K. Surgically managed postoperative hemorrhage after tonsillectomy. Laryngo Rhino Otol. 1996;75(8):447-54.

Pinder D, Hilton M. Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev. 2001;4:CD002211.






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