Intracapsular versus extracapsular tonsil surgery: Comparison of postoperative haemorrhage outcomes in the Australasian setting.

OBJECTIVE

To investigate the incidence and timing of postoperative haemorrhage between intracapsular (ICT) and extracapsular tonsillectomy (ECT) techniques and evaluate factors influencing haemorrhage risk and severity.

METHODS

A retrospective review of patients undergoing tonsillectomy over 5 years across otolaryngology services in Australia and New Zealand. Primary outcomes were rate and timing of post-tonsillectomy haemorrhage.

RESULTS

A total of 12,275 patients were included in this study. The overall post-tonsillectomy bleed rate was 3.3 %, with 0.65 % requiring return to theatre. ICT had a significantly lower bleed rate of 1.7 % compared to 4.1 % for ECT (p < 0.001). The rate of return to theatre was markedly lower for ICT (0.08 %) compared to ECT (0.93 %, p < 0.001). Median day of bleeding was not different between the techniques. Patients undergoing surgery for recurrent tonsillitis had the highest rate of postoperative haemorrhage (15 %), while those with sleep-disordered breathing alone had the lowest (3 %, p < 0.001).

CONCLUSION

ICT results in significantly lower rates of postoperative haemorrhage and need for surgical intervention compared to ECT. This was most pronounced in paediatric patients with sleep-disordered breathing. ICT may be considered a preferable option for certain patient groups, especially younger children with sleep-disordered breathing, though more evidence is needed to confirm its efficacy and safety in patients with recurrent tonsillitis.