Tie or do not tie: comparing knot tying hemostasis in tonsillectomy with other methods of hemostasis. A systematic review and meta-analysis.

PURPOSE: This meta-analysis sought to compare knot tying against other methods of haemostasis in terms of post-operative haemorrhage, intraoperative blood loss and tonsillectomy time.

METHODS

Two independent reviewers performed a literature search according to PRISMA guidelines. Three databases were consulted, Pubmed, Google Scholar and Embase. Studies comparing knot tying with any other form of tonsillectomy haemostasis were included.

RESULTS

Six studies met inclusion criteria for meta-analysis, comprising 1764 patients. When comparing knot tying with other forms of haemostasis there was no significant difference in terms of post-operative haemorrhage rates (odds ratio) (OR: 2.31, 95% CI 0.37 to 14.28, P = 0.37, I2 = 81%). There was significantly less intraoperative blood loss when haemostasis methods other than knot tying were used for tonsillectomy (OR: - 1.66, 95% CI: - 2.64 to - 0.69, P < 0.0008, I2=97%). haemostasis time was significantly shorter without knot tying (OR: - 1.49, 95% CI: - 2.61 to - 0.36, P < 0.01, I2 = 97%) as was total operation time (OR: - 1.93, 95% CI: - 3.61 to - 0.23, P < 0.03, I2 = 97%).

CONCLUSIONS

Tonsillectomy is one of the oldest operations and traditional tonsil surgery has preceded the advent of evidence-based practice. Tie ligation of bleeding vessels is an effective method of securing intraoperative haemostasis and a skill all surgeons should be competent in. Our systematic review and meta-analysis found no evidence to support knot tying of tonsils to prevent post tonsillectomy bleeding compared to any haemostatic intervention during any method of tonsillectomy.