Print ISSN: 1683-3589

Online ISSN: 2409-501X

Keywords : bleeding


ASSESSMENT OF PAIN AND BLEEDING IN THE FIRST POSTOPERATIVE DAY FOLLOWING COBLATION TONSILLECTOMY

Rafid Yaseen Jabbar Almaidi

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 65-68
DOI: 10.33762/bsurg.2020.165490

There are different techniques for tonsillectomy other than traditional such as; cold steel technique, bipolar diathermy, and nowadays the new plasma technology which is known as coblation (controlled ablation) tonsillectomy.
This study aimed to assess the first 24 hours postoperative pain and bleeding after coblation tonsillectomy.
Fifty patients aged between 4-10 years who underwent coblation tonsillectomy were included in this prospective descriptive study, the main indications for tonsillectomy were; recurrent tonsillitis and obstructive sleep apnoea.
The results showed that no bleeding at all within the first 24 hours with significant reduction in feeling of pain after.
In conclusion, coblation tonsillectomy is a promising technique to perform tonsillectomy.
 

THE BENEFICIAL EFFECTS OF TONSILLAR FOSSA CLOSURE AFTER TONSILLECTOMY; A PROSPECTIVE STUDY

Muhanned M Al-Ali; Ahmed M Al-Abbasi; Haider Sabri Hashim; Haider K Saeed; Ali M Altaie

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 32-37
DOI: 10.33762/bsurg.2020.165463

The objective of this study is to evaluate the effect of tonsillar fossa closure after tonsillectomy on the amount of intra-operative blood loss, post-operative pain and bleeding.
 Sixty patients enrolled in this single blind case control study held at Basrah Teaching Hospital in the period from July 2017 to November 2018.  Patients age was between 7 to 50 years, of them 28 (46.7%) females and 32 (53.3%) males. One of tonsillar fossae was selected for closure and the other was left open as a control side, the duration of dissection, the amount of bleeding for each side, the level of post-operative pain on (0, 3, 7, 10-14) days was estimated utilizing Visual Analogue  Score (VAS) together with any evidence of post-operative bleeding.
 There was statistically significant reduction in the level of post-operative pain in the sutured side compared to the control for all the follow-up periods. No significant differences in the amount of intra-operative blood loss between both sides were found. None of the patients experienced post-operative primary or secondary hemorrhage.
 In conclusion, Closure of tonsillar fossa has beneficial effect in reducing the level of
post-operative pain after tonsillectomy with no effect on post-operative bleeding. No difference was noted regarding the amount of intra-operative bleeding.

DOES ANTICOAGULANT THROMBOPROPHYLAXIS INCREASE BLEEDING COMPLICATIONS IN SPINAL SURGERY AND SPINAL CORD INJURY? A SYSTEMATIC REVIEW AND META-ANALYSIS

Anh TV Nguyen; Sonia Tran BMed; Thamer A Hamdan; Robin Turner; Ahmed Ramadan Sadek; Darren Lui; Alexander S Montgomery

Basrah Journal of Surgery, 2020, Volume 26, Issue 1, Pages 9-20
DOI: 10.33762/bsurg.2020.165459

This study is a systematic review and meta-analysis. The routine use of anticoagulants for the prevention of venothromboembolism in spinal patients is controversial and the risk benefit analysis is poorly described. The objective of this study is to collate the current evidence and quantify the risk of bleeding associated with anticoagulant thrombophylaxis in the spinal patient, both in the elective and trauma settings. 
Medline, Embase, Cochrane Trial Register databases and the grey literature were searched. Data were pooled via a meta-analysis from randomized trials and cohort studies comparing the rates of spinal epidural haematoma and wound haemorrhagic complications in spinal surgery patients receiving low molecular weight and low dose unfractionated heparin (LMWH/UFH) thromboprophylaxis and those not anticoagulated. The risk of bias within individual studies and across all the studies was assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, respectively.
 The meta-analysis included 10 studies of 96,042 patients with 1,007 relevant bleeding complications. A significant increase in the risk of extra-spinal wound haemorrhage was found in patients receiving peri-operative LMWH/UFH thromboprophylaxis compared to controls (OR 1.56, 95% CI 1.18-2.06, p=0.002, I2=8%). The same comparison revealed no significant increase in the risk of spinal epidural haemorrhage (OR 1.20, 95% CI 0.65-2.22, p=0.56, I2=0%). The quality of evidence for both outcomes was low. There was insufficient data to conclude about the risk of haemorrhagic complications in spinal trauma and in patients receiving non-heparin thromboprophylaxis agents.
In conclusion, the results of this study raise concern about a possible increased risk of extraspinal wound haemorrhage associated with LMWH/LDUFH thromboprophylaxis in spinal surgery.  Level of evidence: Therapeutic level III.