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.