Frequency of Secondary Hemorrhage Post Tonsillectomy by Dissection and Ligation Method Using Silk 2.0 for Hemostasis
Secondary Hemorrhage Post-Tonsillectomy by Dissection and Ligation Method Using Silk 2.0
DOI:
https://doi.org/10.54393/pjhs.v7i3.3820Keywords:
Electrocoagulation, Hemostasis, Postoperative Hemorrhage, Tonsillectomy, Dissection and Ligation, Tonsillitis/etiology, HemorrhageAbstract
Hemorrhage is one of the most common and serious complications in post-tonsillectomy follow-up. Objective: To find the frequency of post-tonsillectomy hemorrhage using silk 2.0 for hemostasis. Methods: A cross-sectional analytical study was conducted at the Department of Otorhinolaryngology, District Headquarter Teaching Hospital, Gujranwala, from April 2025 to December 2025. 109 patients aged 5–14 years diagnosed with chronic tonsillitis underwent bilateral tonsillectomy by Dissection and Ligation with 35-40 minutes of Surgery duration under general anesthesia. Hemostasis was achieved exclusively using Silk 2.0 suture ligation. Patients were monitored for 28 days postoperatively for evidence of secondary hemorrhage. Data were analyzed using SPSS version 25.0. Quantitative variables were presented as mean ± standard deviation, while categorical variables were expressed as frequency (%). Post-stratification Chi-square testing was performed, and p≤0.050 was considered statistically significant. Results: The mean age was 9.36 ± 2.949 years. Mean BMI was 22.30 ± 2.34 kg/m2. Gender distribution showed that there was female predominance, i.e., 63 (57.8%) were females. Mean duration of disease was 2.39 ± 1.162 years. Out of 109 patients, 11 (10.1%) developed secondary hemorrhage. The data were stratified according to age, gender, BMI, and duration of disease, and results showed that there was no difference between stratification groups in terms of frequency of secondary hemorrhage (p value>0.050). Conclusions: Secondary hemorrhage after bilateral tonsillectomy by Dissection and Ligation is 10.1% by using silk 2.0 suture for hemostasis. The larger studies with the addition of control groups would provide deep insight into the true significance.
References
Dhaduk N, Rodgers A, Govindan A, Kalyoussef E. Post-Tonsillectomy Bleeding: A National Perspective. Annals of Otology, Rhinology and Laryngology. 2021 Aug; 130(8) :941-7. doi: 10.1177/0003489420987438. DOI: https://doi.org/10.1177/0003489420987438
Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ et al. Clinical Practice Guideline: Tonsillectomy in Children. Otolaryngology–Head and Neck Surgery. 2011 Jan; 144(1_suppl): S1-30. doi: 10.1177/0194599810389949. DOI: https://doi.org/10.1177/0194599810389949
Ahmad MU, Wardak AN, Hampton T, Siddiqui MR, Street I. Coblation versus Cold Dissection in Pediatric Tonsillectomy: A Systematic Review and Meta-Analysis. The Journal of Laryngology and Otology. 2020 Mar; 134(3): 197-204. doi: 10.1017/S0022215120000377. DOI: https://doi.org/10.1017/S0022215120000377
Suzuki M, Miyaji K, Watanabe R, Suzuki T, Matoba K, Nakazono A et al. Repetitive Simulation Training with Novel 3D‐Printed Sinus Models for Functional Endoscopic Sinus Surgeries. Laryngoscope Investigative Otolaryngology. 2022 Aug; 7(4): 943-54. doi: 10.1002/lio2.873. DOI: https://doi.org/10.1002/lio2.873
Alenezi MM, Al-Harbi FA, Almoshigeh AN, Alruqaie SS, Alshahrani NM, Alamro AM et al. Comparison of Post-Tonsillectomy Hemorrhage Rate After Different Tonsillectomy Techniques: Systematic Review and Meta-Analysis. Clinics and Practice. 2025 Apr; 15(5): 85. doi: 10.3390/clinpract15050085. DOI: https://doi.org/10.3390/clinpract15050085
Bhatti S, Tarar JM, Ashraf MA, Tahir M. Clinical Risk Factors of Post-Surgery Hemorrhage in Patients Undergoing Tonsillectomy: Post-Surgery Hemorrhage in Patients Undergoing Tonsillectomy. Pakistan Journal of Health Sciences. 2025 Apr: 161-5. doi: 10.54393/pjhs.v6i4.2868. DOI: https://doi.org/10.54393/pjhs.v6i4.2868
Schafer A, Worobetz N, Lukens J, Bourgeois T, Onwuka A, Elmaraghy C et al. Assessing the Relationship Between Infection Frequency and Risk of Post-Tonsillectomy Hemorrhage. Annals of Otology, Rhinology & Laryngology. 2023 Nov; 132(11): 1424-9. doi: 10.1177/00034894231159328. DOI: https://doi.org/10.1177/00034894231159328
Mane BS and Gavali RM. A Comparative Study between Lower Pole Silk Ligation and Pillar Suturing Technique of Hemostasis in Tonsillectomy. An International Journal of Otorhinolaryngology Clinics. 2024 Jan; 15(3): 103-6. doi: 10.5005/jp-journals-10003-1453. DOI: https://doi.org/10.5005/jp-journals-10003-1453
Batool F, Ghani S, Asif M, Haroon T, Ibrahim M, Mohammad N. Comparison of Post-Tonsillectomy Hemorrhage Rate in Patients Undergoing Two Commonly Used Tonsillectomy Methods. The Professional Medical Journal. 2024 Jul; 31(07): 1106-12. doi: 10.29309/TPMJ/2024.31.07.8144. DOI: https://doi.org/10.29309/TPMJ/2024.31.07.8144
Arif M, Noor A, Anwar K, Khan S. Frequency of Post-Tonsillectomy Secondary Hemorrhage. Khyber Journal of Medical Sciences. 2024; 17(4): 222-6. doi: 10.70520/kjms.v17i4.241. DOI: https://doi.org/10.70520/kjms.v17i4.241
Saravakos P and Hartwein J. Surgical Technique and Post-Tonsillectomy Hemorrhage: A Single Institution’s Retrospective Study. European Archives of Oto-Rhino-Laryngology. 2017 Feb; 274(2): 947-52. doi: 10.1007/s00405-016-4271-3. DOI: https://doi.org/10.1007/s00405-016-4271-3
Randall DA and Hoffer ME. Complications of Tonsillectomy and Adenoidectomy. Otolaryngology--Head and Neck Surgery. 1998 Jan; 118(1): 61-8. doi: 10.1016/S0194-5998(98)70376-6. DOI: https://doi.org/10.1016/S0194-5998(98)70376-6
Inuzuka Y, Mizutari K, Kamide D, Sato M, Shiotani A. Risk Factors of Post‐Tonsillectomy Hemorrhage in Adults. Laryngoscope Investigative Otolaryngology. 2020 Dec; 5(6): 1056-62. doi: 10.1002/lio2.488. DOI: https://doi.org/10.1002/lio2.488
Liu Q, Zhang Y, Lyu Y. Postoperative Hemorrhage Following Coblation Tonsillectomy with and Without Suture: A Randomized Study in Chinese Adults. American Journal of Otolaryngology. 2021 Jan; 42(1): 102760. doi: 10.1016/j.amjoto.2020.102760. DOI: https://doi.org/10.1016/j.amjoto.2020.102760
Li B, Wang M, Wang Y, Zhou L. Can Intraoperative Suturing Reduce the Incidence of Post-Tonsillectomy Hemorrhage? A Systematic Review and Meta‐Analysis. Laryngoscope Investigative Otolaryngology. 2022 Aug; 7(4): 1206-16. doi: 10.1002/lio2.835. DOI: https://doi.org/10.1002/lio2.835
Patel SD, Daher GS, Engle L, Zhu J, Slonimsky G. Adult Tonsillectomy: An Evaluation of Indications and Complications. American Journal of Otolaryngology. 2022 May; 43(3): 103403. doi: 10.1016/j.amjoto.2022.103403. DOI: https://doi.org/10.1016/j.amjoto.2022.103403
Gonçalves AI, Rato C, de Vilhena D, Duarte D, Lopes G, Trigueiros N. Evaluation of Post-Tonsillectomy Hemorrhage and Assessment of Risk Factors. European Archives of Oto-Rhino-Laryngology. 2020 Nov; 277(11): 3095-102. doi: 10.1007/s00405-020-06060-1. DOI: https://doi.org/10.1007/s00405-020-06060-1
Patel NK, Shah SJ, Lee NK, Gao Q, Carullo VP, Yang CJ. Intraoperative Intravenous Ibuprofen Use Is Not Associated with Increased Post-Tonsillectomy Bleeding. International Journal of Pediatric Otorhinolaryngology. 2020 Jun; 133: 109965. doi: 10.1016/j.ijporl.2020.109965. DOI: https://doi.org/10.1016/j.ijporl.2020.109965
Kostić M, Ivanov M, Babić SS, Tepavčević Z, Radanović O, Soković M et al. Analysis of Tonsil Tissues from Patients Diagnosed with Chronic Tonsillitis—Microbiological Profile, Biofilm-Forming Capacity and Histology. Antibiotics. 2022 Dec; 11(12): 1747. doi: 10.3390/antibiotics11121747. DOI: https://doi.org/10.3390/antibiotics11121747
Wu S, Hammarstedt-Nordenvall L, Jangard M, Cheng L, Radu SA, Angelidou P et al. Tonsillar Microbiota: A Cross-Sectional Study of Patients with Chronic Tonsillitis or Tonsillar Hypertrophy. Msystems. 2021 Apr; 6(2): 10-128. doi: 10.1128/msystems.01302-20. DOI: https://doi.org/10.1128/msystems.01302-20
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Pakistan Journal of Health Sciences

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments



