Reducing post operative bleeding after tonsillectomies in children by modifying the monopolar diathermy technique: a study of 1500 patients

To evaluate the effects of modifications of the present technique of monopolar diathermy tonsillectomy on the incidence of post operative bleeding and compare them with international data for tonsillectomies done without modifications. This is a prospective, longitudinal experimental study. Fifteen hundred patients were studied from January 2000 to January 2008. Patient's age ranged from five to fifteen years. All patients underwent tonsillectomies by modified monopolar diathermy method. The incidence of postoperative bleeding was assessed. Two patients developed significant secondary haemorrhage, which is defined as requiring a return to the operating theater for the control of bleeding. One patient with secondary bleed required blood transfusion in addition to a return to the operating theater. Five patients developed minor secondary bleed that was controlled by conservative means. Two patients developed reactionary bleeding that was controlled in the operating room before return of the patient to the bed. Modifications in the existing technique produces a significantly lower incidence of post operative bleeding from the tonsillar fossae and compares well than those reported in the international literature

Use of drainage after thyroid surgery: is it evidence based?

To assess whether a Surgical Drain is an absolute necessity after Thyroidectomy. Prospective, comparative study from Feb. 2000 to Feb. 2005. Hamdard University Hospital, Patel Hospital, Kitiyana Memon Hospital, Masoomeen Hospital and K.V SITE Social Security Hospital in Karachi. A total of 150 patients who presented with a Goitre and underwent surgery. Detailed data of the patients was recorded, and they were alternately assigned to two different groups viz. "Drain group" and Non-Drain group". Both groups underwent surgery. Out of 150 patients, six [4%] from the Non-drain groups developed serous collections which were aspirated, whereas nine [6%] patients from the Drain group developed complications. These included two [1.3%] cases with bilateral recurrent nerve paralysis, one [0.67%] with unilateral recurrent nerve paralysis, five [3.3%] with transient recurrent nerve palsy and one [0.67%] case with superior laryngeal nerve paralysis. Thyroid surgery should be performed by experienced thyroid surgeons. To minimize bleeding, designated steps be followed like staying in the subplatysmal plane, using coagulation diathermy, staying close to the thyroid, identification of the vessels with precise ligation. Meticulous haemostasis precludes drainage of the operative area and prevents complications