Efficacy of Ligation versus Bipolar Diathermy for Management of Intraoperative Haemostasis in Tonsillectomy: A Prospective Interventional Study

1. Junior Resident, Department of Otorhinolaryngology and Head Neck Surgery, Dr. D. Y. Patil College, Hospital and Research Center, Pune, Maharashtra, India. 2. Professor and Head, Department of Otorhinolaryngology and Head Neck Surgery, Dr. D. Y. Patil College, Hospital and Research Center, Pune, Maharashtra, India. 3. Professor, Department of Otorhinolaryngology and Head Neck Surgery, Dr. D. Y. Patil College, Hospital and Research Center, Pune, Maharashtra, India. 4. Assistant Professor, Department of Otorhinolaryngology and Head Neck Surgery, Dr. D. Y. Patil College, Hospital and Research Center, Pune, Maharashtra, India.

Abstract

Introduction: Tonsillitis is a highly prevalent condition and represents a significant proportion of outpatient visits. Tonsillectomy, when indicated, is considered a high-risk procedure owing to the postoperative complications. Bipolar diathermy coagulation has gained popularity due to its potential advantages, including reduced intraoperative blood loss, fewer postoperative complications, shorter operative time, and improved postoperative recovery.

Aim: To compare the efficacy of ligation and bipolar diathermy for haemostasis in tonsillectomy.

Materials and Methods: The present prospective interventional study was conducted from October 2023 to March 2025, in the Department of Otorhinolaryngology at a tertiary care hospital, involving 40 patients undergoing elective tonsillectomy. Patients were randomly allocated into two equal groups (n=20 each) based on the method of haemostasis: Group A underwent tonsillectomy with haemostasis achieved using ligation with 3-0 vicryl sutures. In contrast, group B underwent haemostasis using bipolar diathermy coagulation. Both groups were evaluated for intraoperative time (measured in minutes using a stopwatch), intraoperative blood loss (calculated by measuring suction volume and gauze weight), postoperative pain (assessed using the Visual Analog Scale (VAS) on postoperative days 0, 3, and 5), and postoperative complications such as secondary haemorrhage, infection, and delayed healing. Intergroup comparisons were performed using the independent samples student’s t-test for continuous variables and the Chi-square test or Fisher’s-exact test for categorical variables. A p-value of <0.05 was considered statistically significant.

Results: The mean age was 18.6±4.2 years in group A and 19.1±3.8 years in group B (p=0.612). Gender distribution was similar, with a male-to-female ratio of 12:8 in group A and 11:9 in group B (p=0.748). Patients in group B, demonstrated a significantly shorter mean haemostasis time (8.4±2.9 minutes) in comparison to group A (10.9±3.8 minutes), (p=0.02). The mean intraoperative blood loss was also significantly reduced in group B (23.8±6.1 mL) compared to group A (34.5±6.6 mL), p-value of <0.001. On postoperative day 0 (POD 0), the mean pain score in group B was 4.9±1.4, compared to 3.2±1.0 in group A (p<0.001). On POD 3, the mean scores were 2.7±0.8 in group B and 2.2±0.7 in group A (p=0.04), while on POD 5, group B reported a score of 1.8±0.6, which remained significantly higher than 1.3±0.4 in group A (p=0.003). Although postoperative pain scores decreased progressively in both groups, the differences persisted across the observation period, indicating a higher early postoperative pain burden associated with bipolar diathermy. Group A had complications in 5 cases (25%), comprising 2 cases (10%) of primary haemorrhage, 1 case (5%) of injury to the posterior pharyngeal wall, 1 case (5%) of soft palate injury, and 1 case (5%) of reactionary haemorrhage. In contrast, group B exhibited a lower complication rate in 3 cases (15%), which included 1 case (5%) of hypernasal speech, 1 case (5%) of injury to the anterior tonsillar pillar, and 1 case (5%) of transient velopharyngeal insufficiency.

Conclusion: Haemostasis using bipolar diathermy appears to be more efficient and safer technique for tonsillectomy with reduced operative time and quicker recovery, making it a favourable alternative to traditional ligation.

Lymphoid tissue, Palatine tonsil, Tonsillitis