Nuestra experiencia en amigdalectomía en los años 2013-2017 en el Hospital Clínico Universitario de Valladolid

Abstract

Introduction and objective: Tonsillectomy is a frequent procedure in pediatric otorhinolaryngology. Currently it is mainly indicated in tonsillar hypertrophy associated with obstructive sleep disorder, recurrent tonsillitis or tonsillar asymmetry. Hemorrhage is considered the biggest complication after this surgery and the most feared; its incidence is estimated between 2 and 5% but the series vary a lot, with up to 20% being documented in some study. Our objective is to review the experience in tonsillectomy during the years 2013 to 2017.Material and Method: we have made a prospective study of 442 patients undergoing tonsillectomy associated or not with adenoidectomy between 2013-2017 in our hospital. We have collected information regarding age, sex, diagnosis, surgical technique, days of admission, postoperative bleeding and treatment performed in this case.Results: We have obtained a sample of 442 patients with ages ranging from 1 year to 78 years; 76.9% were patients under 14 years of age. Regarding sex, 45.9% were female and the remaining 54.1% were male. The main indications for surgery were recurrent tonsillitis and sleep apnea hypopnea syndrome. A total of 315 adenotonsillectomies and 121 tonsillectomies were performed. In 6 patients the tonsillectomy was unilateral due to suspicion of neoplasia. The average hospital stay was 1.3 days. The most used technique in our hospital is cold dissection and hemostasis with bipolar forceps and compression for tonsils and curettage with adenotome for the adenoids, with posterior compression for hemostasis. Of the total patients, 20 suffered postsurgical bleeding (4.52%): 8 were immediate (first 24 hours), in 11 the bleeding was delayed (weekly) and in one case the patient bled twice (in the first 24 hours and a week later). In all of them, the previous coagulation study was normal. In ten out of this 20 patients, it was necessary to re-operate to control the hemorrhage. Apart from compression and bipolar forceps we used in some cases hemostatic substances such as "floseal" being effective to co-regulate bleeding.Conclusions: Tonsillectomy is a frequent procedure in our day to day work. It is important to be strict in the selection of the candidate for surgery, firstly because as we have seen a very high volume of patients are in pediatric age (in our sample almost 80% are under 14 years of age). Secondly, because It is a surgery that is not free of complications such as bleeding which sometimes forces the patient to re-enter and re-undergo general anesthesia to control it. We have no way of predicting the bleeding; hence vigilance is especially important in children during the first 24 hours.