Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study

BACKGROUND: Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TE(mic)) could be assumed to decrease PTH compared to traditional tonsillectomy (TE(trad)). METHODS: In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured. RESULTS: 869 patients were included (183 TE(mic); 686 TE(trad)). PTH requiring RTT was not seen in the TE(mic) group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TE(mic) group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TE(trad) were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p > 0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p = 0.007). CONCLUSION: Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TE(mic) group. Benefit for TE(mic) was observed in high-volume and long experienced surgeons.