How can parents make decision on tonsillectomy?
Tonsillectomy is the second commonest operation performed in the UK after dental extraction. However, it is not without its complications. One of the commonest complication is bleeding after the operation (post tonsillectomy bleed). If bleeding happens after tonsillectomy, it is usually in the second week (7-10 days after operation). This is thought to be due to infection (only anecdotal evidence). The chances of a post tonsillectomy bleed is 6 out of 100 in most of the experienced surgical hands. So that means majority of the patients (94/100) do not bleed. Out of the 6 that can bleed, one child will have to be taken to theatre to stop the bleeding. Very rarely, a child requires blood transfusion. This bleeding is almost always something that can be stopped.
The problem arises when a child under 13kg requires tonsillectomy. This is usually due to obstructive sleep apnoea (OSA) caused by large tonsils and adenoids. For such a child, tonsillectomy is beneficial as it helps them to have a good night sleep, gets relief from OSA and prevents further strain on heart and brain function due to better blood circulation.
Why post tonsillectomy bleed should be acted upon quickly?
The blood volume of a child with 13kg is only around 1Litre. If this child loses say 1 cup of blood after operation, this amounts to about 15 percent of total body blood volume. This child needs urgent medical attention.
However, bear in mind that the chances of this happening is only 6/100. Even then, it is very important that the parents realise the need to seek urgent medical attention. I think an awareness about dangers of post tonsillectomy bleed especially in children under 13kg is always good.
What includes post tonsillectomy bleeds?
Any bright red blood coming from the nose or seen in the mouth indicates fresh bleeding. This needs medical attention. It is normal for child to cough and spit some saliva with streaks of blood during the first few days after tonsillectomy. This is considered normal and is due to granulations developing at the operated site. However it is better to get this checked by GP.
In children, most often they don’t know how to spit blood. Instead they keep swallowing blood. Since blood is an irritant to stomach, they ultimately vomit. The vomitus usually contains blood clots. This means the child has been swallowing the blood and hence needs urgent medical attention.
For children under 13kg, I would recommend Coblation Intracapsular Tonsillectomy.
Advantages of Coblation Intracapsular Tonsillectomy:
- Less bleeding during surgery
- Minimal trauma to surrounding tissues
- Less pain and a speedy recovery after operation
- Able to resume to normal diet within hours. Eating normally after surgery helps to reduce chances of infection remarkably. This in turn reduces chance of post tonsillectomy bleed.
Please refer to http://princemodayil.com/downloads/Coblation-tonsillotomy.pdf