gms | German Medical Science

Introduction: Whenever new tonsillectomy techniques arise, they are compared with the so called „standard” or “conventional” tonsillectomy. However, the term „standard“ or „conventional“ is loosely defined in the literature. This study was undertaken to evaluate whether or not tonsillectomies are uniformly performed in Germany. Moreover, the incidence of post-tonsillectomy hemorrhage with lethal outcome was subject of our investigation.

Methods: A questionnaire was send to 156 teaching hospitals including 37 university hospitals. Surgical techniques of dissection, methods to achieve hemostasis as well as the incidence of primary (<24 h) and secondary (>24 h) hemorrhage and cases with lethal outcome were inquired

Results: 133 answers were received by November 2007 (response rate: 85.3%). In 2006 a total of 52.076 tonsillectomies were performed in the institutions (mean: 391 procedures/hospital; median: 358; STD: 195,86). While most hospitals (104) used cold dissection techniques, 78 used either suture ligations as well as electrosurgical means to achieve hemostasis. Secondary hemorrhage clearly prevailed (92). Episodes of bleeding with lethal outcome were registered for one patient following tonsillectomy, tonsillotomy and tumor-tonsillectomy, respectively.

Conclusion: The term „standard tonsillectomy“ encompasses different surgical techniques. Electrosurgical means to achieve hemostasis are significantly associated with the incidence of delayed hemorrhage which was not found for the different techniques of dissection. The incidence of lethal post-tonsillectomy hemorrhage is rare but may follow intracapsular tonsillectomy (“tonsillotomy”).