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BİNNETOĞLU, ADEM

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BİNNETOĞLU

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Start date: 2015 × Subject: ADENOIDECTOMY ×

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    Is it safe to perform adenotonsillectomy in children with Down syndrome?
    (SPRINGER, 2016) BİNNETOĞLU, ADEM; Yumusakhuylu, Ali Cemal; Binnetoglu, Adem; Demir, Berat; Baglam, Tekin; Sari, Murat
    This retrospective review aims to evaluate the postoperative morbidity and mortality of 30 patients with Down syndrome who underwent adenotonsillectomy between June 2012 and December 2015 in a tertiary referral center. Mean age was 7.8 with a range of 3-12. There were 20 (66.6 %) male and ten (33.3 %) female patients. Mean follow-up was 23 months with a range of 7-43 months. 23 (76.6 %) of 30 patients had been operated due to obstructive tonsillar and adenoid hypertrophy, whereas seven (23.3 %) of them operated for chronic recurrent infections. All of the patients had undergone adenotonsillectomy operation; one patient had also bilateral tympanostomy tube insertion. Hospital stay was noted 1.3 days in average with a range of 1-3 days. Anesthetic complications of persistent bradycardia and postextubation respiratory difficulty occurred in two (6.6) patients. Patient who had intraoperative bradycardia necessitated intensive care unit stay and pacemaker implantation during follow-up. 3 (10 %) patients had late onset hemorrhage between days 7 and 10 and required intraoperative bleeding control. We did not experience any other morbidity and mortality except the abovementioned ones. In conclusion, adenotonsillectomy in patients with Down syndrome is a worthwhile operation with certain risks and these operations should better be performed by the tertiary referral centers which have the capacity to deal with the complications.
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    PublicationOpen Access
    Use of a Gelatin-Thrombin Hemostatic Matrix for Secondary Bleeding After Pediatric Tonsillectomy
    (AMER MEDICAL ASSOC, 2016-10-01) BİNNETOĞLU, ADEM; Binnetoglu, Adem; Demir, Berat; Yumusakhuylu, Ali Cemal; Baglam, Tekin; Sari, Murat
    IMPORTANCE Secondary posttonsillectomy bleeding associated with oozing from multiple sites or overcauterized tonsillar bed deserves special evaluation. OBJECTIVE To evaluate the use of an absorbable, flowable gelatin-thrombin hemostatic matrix (GTHM) sealant for secondary bleeding after tonsillectomy. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective data analysis, with information gathered from medical records of pediatric patients with secondary posttonsillectomy bleeding treated with the GTHM between 2012 and 2016 at a referral center and a local satellite facility. Forty-two pediatric patients admitted with secondary bleeding after tonsillectomy characterized by diffuse bleeding, multiple bleeding sites, or an overcauterized tonsillar bed, were treated with GTHM. Exclusion criteria were a bleeding disorder, genetic syndrome associated with abnormal oropharyngeal anatomy, and hemorrhage from a single site. EXPOSURES GTHM was used to treat posttonsillectomy secondary bleeding. MAIN OUTCOMES AND MEASURES Patient medical records were reviewed for information relevant to this study: (1) patient history, the tonsillectomy surgical technique used, and whether there were prior bleeding episodes (and if so, methods of treatment); (2) physical examination and laboratories on presentation, operative report details, and results of treatment; (3) hospital course and whether any further bleeding episodes occurred; and (4) hospital follow-up information (range, 3-20 months). RESULTS The study population comprised 22 boys (52%) and 20 girls (48%) (a total of 42 patients), and the mean (SD) age was 7 (2.7) years (range, 4-14 years). Two patients had presented with recurrent secondary bleeding necessitating multiple operations, but the others had only 1 episode. The mean day of occurrence of bleeding was on the eighth day (range, day 7-12; median, day 10). Only 2 patients required blood transfusions: they were the same patients who underwent multiple operations for recurrent episodes of secondary bleeding. All patients except for 1 (41 of 42) were discharged without further bleeding following treatment. No adverse effects were reported. CONCLUSIONS AND RELEVANCE Results suggest that GTHM is generally simple, safe, and effective for use in the treatment of posttonsillectomy secondary bleeding types not associated with a direct vein or artery source but oozing from multiple sites and/or overcauterized tonsillar bed that cannot be stopped by traditional hemostatic methods.