Argon Beam Coagulation for Post-Tonsillectomy Hemostasis

OBJECTIVE: The study goal was to evaluate the effectiveness of argon beam coagulation (ABC) in the prevention of post-tonsillectomy hemorrhage. ABC provides monopolar coagulation by arcing ionized argon gas to the target tissue; it is not a laser.

METHODS: Two consecutive studies were performed as follows. In the first, a retrospective analysis of post-tonsillectomy bleeding in 344 patients was conducted. Final tonsil fossa hemostasis was achieved with ABC (257 patients) or with electrocoagulation (EC) (87 patients). In the second, a prospective, randomized, patient-blind study of post-tonsillectomy bleeding was conducted in 88 patients. Final hemostasis was achieved using ABC in one fossa and EC in the other fossa, with the sides chosen at random.

RESULTS: Post-tonsillectomy hemorrhage was defined as the expectoration of fresh blood, as opposed to blood-streaked saliva. The rates of bleeding for the 2 studies were as follows. In study 1 for EC, 20% for adults, 6.5% for children, and 10.3% for total; for ABC, 4.7% for adults, 0.6% for children, and 1.9% for total. In study 2 for EC, 19.2% for adults, 1.6% for children, and 6.8% for total; for ABC, 7.7% for adults, 0.0% for children, and 1.1% for total. The rates of hospital admission for observation or reoperation to treat the bleeding in study 1 for EC were 8% for adults, 6.5% for children, and 6.9% for total; for ABC, 1.2% for adults, 0.6% for children, and 0.7% for total. Corresponding rates for study 2 for EC were 15.4% for adults, 1.6% for children, and 5.7% for total; for ABC, 3.8% for adults, 0.0% for children, and 1.1% for total.

CONCLUSION: ABC is more effective than EC for hemostasis after tonsillectomy. The costs of ABC use vs the savings achieved from reduced bleeding are discussed.