Safety of Cold Tonsillectomy Techniques: Comparison between Wired Snare and Inferior Tonsillar Pole Ligation Methods

Objective: The aim of this study was to assess the safety of wired snare method compared with inferior tonsillar pole ligation method as techniques used in cold dissection tonsillectomy. Study design: Prospective, case series study with six months follow up. Setting: Al-Fallujah Teaching Hospital, Al-Anbar, Iraq. Subjects and methods: This was a hospital based prospective study performed in the Department of Ear, Nose and Throat, from July 2012 to June 2013, during this period 210 patients underwent tonsillectomy by same surgeon. Tonsillectomy done by cold dissection technique, one side the inferior tonsillar pole ligated by silk, the other side in the same patient, the inferior pole had been taken with cold wire snare, the selection done randomly. Bipolar diathermy forceps were used for tonsillar bed homeostasis adenoidectomy done by curettage if indicated. Follow up continued for the next six months. Results: The indication for tonsillectomy was mainly due to recurrent acute or chronic tonsillitis (75.2%). Early complications as primary bleeding happened more with wired snare method (four times) as well as the reactionary hemorrhage, on the other hand the anesthetic complications (four times), trauma to base of tongue and tonsillar remnant happened more with inferior tonsillar pole ligation method. Late complications were very limited after both procedures. Conclusion: From this study we concluded that wired snare method carried more risk of bleeding, while inferior tonsillar pole ligation method associated with more anesthetic, traumatic and tonsillar remnant complications. Citation: Al-Juboori AN. Safety of Cold Tonsillectomy Techniques: Comparison between Wired Snare and Inferior Tonsillar Pole Ligation Methods. 2016;3(1): 4. Inter J Otorhinolaryngology 3(1): 4 (2016) Page 02 ISSN: 2380-0569 abscess (quinsy). Tonsillectomy done under general anesthesia with endotracheal intubation, and the patient with standard tonsillectomy position, a Boyle Davis gag is in situ. A mucosal incision was made with scissors between the tonsil and anterior pillar in keeping with a cold dissection technique i.e. the procedure done by cold dissection method, one side the lower tonsillar pole taken by Negus artery forceps and ligated by 3/0 silk (Figure 1a), the opposite tonsillar side in the same patient, the lower pole had been taken with cold wire snare randomly (Figure 1b), this means that selection of right or left side were chosen randomly for each technique. Bipolar diathermy forceps were used for tonsillar bed hemostasis. Adenoidectomy underwent by curettage if indicated. The assessment of blood loss quantity is done by measuring the amount of blood loss and the number of swabs used in each side. Data was collected intra-operatively and during the first 24 hours post-operative, the follow up continued for the coming two weeks after the procedure as well as for the next six months either by visits or by phone. Bleeding during tonsillectomy, i.e. primary hemorrhage was very important complication, reactionary hemorrhage happened within the first 24 hours after tonsillectomy, while secondary hemorrhage occurred after the first postoperative day after the procedure as a result of infection.