Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-23T07:41:27.108Z Has data issue: false hasContentIssue false
  • English
  • Français

Guillotine versus dissection tonsillectomy: randomised, controlled trial

Published online by Cambridge University Press:  11 September 2012

S J Frampton ,
M J A Ward ,
V S Sunkaraneni ,
H Ismail-Koch ,
Z A Sheppard ,
R J Salib  and
P K Jain
S J Frampton
Affiliation:
Department of Otolaryngology, Poole Hospital NHS Foundation Trust, UK
M J A Ward
Affiliation:
Department of Otolaryngology, Poole Hospital NHS Foundation Trust, UK
V S Sunkaraneni
Affiliation:
Department of Otolaryngology, University Hospital Southampton NHS Foundation Trust, UK
H Ismail-Koch
Affiliation:
Department of Otolaryngology, University Hospital Southampton NHS Foundation Trust, UK
Z A Sheppard
Affiliation:
School of Health and Social Care, Bournemouth University, UK
R J Salib
Affiliation:
Department of Otolaryngology, University Hospital Southampton NHS Foundation Trust, UK
P K Jain*
Affiliation:
Department of Otolaryngology, Poole Hospital NHS Foundation Trust, UK
*
Address for correspondence: Dr Parmod K Jain, Department of Otolaryngology, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK Fax: +44 (0)1202 448 410 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This trial aimed to compare the guillotine technique of tonsillectomy with ‘cold steel’ dissection, the current ‘gold standard’.

Design:

A single centre, randomised, controlled trial.

Methods:

One hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intra-operative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared.

Results:

Operative time and intra-operative blood loss were both significantly less for the guillotine technique (p < 0.001) and there was a significantly reduced haemostasis requirement (p < 0.001). Pain was also less on the guillotine side (p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage.

Conclusion:

This study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.

Keywords

TonsillectomyPain, PostoperativePostoperative ComplicationsEfficiency
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 11 , November 2012 , pp. 1142 - 1149
Copyright
Copyright © JLO (1984) Limited 2012

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.)

Footnotes

Presented orally at the British Association for Paediatric Otolaryngology Meeting, 17th September 2010, London, UK, and as a poster at the American Academy of Otolaryngology–Head and Neck Surgery Meeting, 26–29 September 2010, Boston, Massachusetts, USA, and at the 1st Congress of the Confederation of European Otorhinolaryngology and Head and Neck Surgery, 2nd July 2011, Barcelona, Spain

References

1 McGuire, NG. A method of guillotine tonsillectomy with an historical review. J Laryngol Otol 1967;81:187–95CrossRefGoogle ScholarPubMed
2 Lowe, D, Van der Meulen, J, Cromwell, D, Lewsey, J, Copley, L, Browne, J et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117:717–24Google Scholar
3 Mathews, J, Lancaster, J, Sherman, I, Sullivan, GO. Guillotine tonsillectomy: a glimpse into its history and current status in the United Kingdom. J Laryngol Otol 2002;116:988–91Google Scholar
4 Sunkaraneni, VS, Ismail-Koch, H, Salib, RJ, Jain, PK. Guillotine tonsillectomy: a neglected technique. J Laryngol Otol 2009;123:907–9CrossRefGoogle ScholarPubMed
5 Jain, PK. How we do it: Jain tonsil ‘A’ frame – a solution to slipping rods. Clin Otolaryngol 2005;30:274–5CrossRefGoogle Scholar
6 Wake, M, Glossop, P. Guillotine and dissection tonsillectomy compared. J Laryngol Otol 1989;103:588–91Google Scholar
7 Weligodapola, GS. Comparative study of tonsillectomy performed by guillotine and dissection methods. J Laryngol Otol 1983;97:605–6Google Scholar
8 Unlu, Y, Tekalan, SA, Cemiloglu, R, Ketenci, I, Kutluhan, A. Guillotine and dissection tonsillectomy in children. J Laryngol Otol 1992;106:817–20CrossRefGoogle ScholarPubMed
9 Homer, JJ, Williams, BT, Semple, P, Swanepoel, A, Knight, LC. Tonsillectomy by guillotine is less painful than by dissection. Int J Pediatr Otorhinolaryngol 2000;52:25–9Google Scholar
10 Yuan, CC, Yu, DY, Jun, TS, Quan, CR. Guillotine tonsillectomy without anesthesia. Auris Nasus Larynx 1984;11:29–35 Google Scholar
11 Carrick, DG. Salicylates and post-tonsillectomy haemorrhage. J Laryngol Otol 1984;98:803–5Google Scholar
12 Williams, RG. Haemorrhage following tonsillectomy and adenoidectomy. (A review of 18,184 operations). J Laryngol Otol 1967;81:805–8Google Scholar
13 Roberts, C, Jayaramachandran, S, Raine, CH. A prospective study of factors which may predispose to post-operative tonsillar fossa haemorrhage. Clin Otolaryngol Allied Sci 1992;17:13–17 CrossRefGoogle ScholarPubMed

Frampton Supplementary Material

Movie

Download Frampton Supplementary Material(Video)
Video 66 MB