Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-23T10:26:28.971Z Has data issue: false hasContentIssue false

Combined study to assess the role of calcium alginate swabs and ligation of the inferior tonsillar pole in the control of intra-operative blood loss during tonsillectomy

Published online by Cambridge University Press:  29 June 2007

J. F. Sharp
Affiliation:
Edinburgh
M. J. C. Rogers
Affiliation:
Edinburgh
M. Riad
Affiliation:
Edinburgh
A. I. G. Kerr*
Affiliation:
Edinburgh
*
Dr. A. I. G. Kerr, Consultant Otolaryngologist, 39 Lauriston Place, The Royal Ifirmary, Edinburgh EH3 9EN.

Abstract

Bleeding is the major source of morbidity and mortality of tonsillectomy and most operative time is spent securing haemostasis. Calcium alginate reduces experimental wound blood loss. This study assessed the efficacy of alginate swabs during tonsillectomy and inferior tonsillar pole ligation in the control of blood loss during tonsillectomy.

Ninety-nine tonsillectomy patients were randomized to gauze or alginate swab use. A haemoglobinometer measured blood losses collected by suction during dissection and by swab until haemostasis was secured. Operative time, complications and healing were also assessed.

Mean total blood losses and operative times were similar for the two groups. Swab blood loss was significantly lower for surgeons who ligated the lower tonsillar pole, compared with surgeons who used a snare. This finding was independent of swab type. Independent assessment showed no difference in the healing rate.

Alginate swabs offer no advantage over gauze in terms of blood loss, operative time or complications of tonsillectomy. The results show that routine lower pole ligation significantly reduces post-dissection blood loss. We suggest that this technique should be more widely adopted.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arora, Y. R., Manford, M. L. M. (1979) Operative blood loss and the frequency of haemorrhage associated with adenotonsillectomyin children: a double blind trial of Ethamsylate. British Journal of Anaesthesia, 51: 557560.CrossRefGoogle ScholarPubMed
Barnett, S. E., Varley, S. J. (1987) The effects of calcium alginate on wound healing. Annals of Royal College of Surgeons of England, 69: 153155.Google ScholarPubMed
Blaine, G. B. (1947) Experimental observations on absorbable alginate products in surgery. Annals of Surgery, 125: 102107.CrossRefGoogle ScholarPubMed
Blair, S. D., Blackhouse, C. M., Harper, R., Matthews, J., McCollum, C. N. (1988) Comparison of absorbable materials for surgical haemostasis. British Journal of Surgery, 75: 969971.CrossRefGoogle ScholarPubMed
Broadman, L. M., Patel, R. I., Feildman, B. A., Sellman, G. L., Milmore, G., Camilon, F. (1989) Effects of pentonsillar infiltration on the reduction of intra-operative blood loss and post-tonsillectomy pain in children. Laryngoscope, 99(6): 578581.CrossRefGoogle Scholar
Groves, A. R., Lawrence, J. C. (1986) Alginate dressing as a donor site haemostat. Annals of Royal College of Surgeons of England, 68: 2728.Google ScholarPubMed
Jarvis, P. M., Galvin, D. A. J., Blair, S. D., McCollum, C. N. (1987) How does calcium alginate achieve haemostasis in surgery? Thrombosis and Haemostasis. 58: 50.Google Scholar
Kristensen, S., Tveteras, K. (1984) Post-tonsillectomy haemorrhage: A retrospective study of 1150 operations. Clinical Otolaryngology, 9: 347350.CrossRefGoogle ScholarPubMed
Overbosch, H. C., Hart, H. C. (1970) Local application of epsilon animocaproic acid (EACA) in the prevention of haemorrhage after tonsillectomy. Journal of Laryngologyand Otology, 84: 905908.CrossRefGoogle ScholarPubMed
Tami, T. A., Parker, G. S., Taylor, R. E. (1987) Post-tonsillectomy bleeding: An evaluation of risk factors. Laryngoscope, 97: 13071311.CrossRefGoogle ScholarPubMed
Thomas, G. K., Arbon, R. A. (1970) Preoperative screening of potential tonsil and adenoid bleeding. Archives of Otolaryngology, 91: 453456.CrossRefGoogle Scholar