Combined extracapsular and intracapsular tonsillectomy: Lower pole capsule preservation

Although tonsillectomy has a very long history as one of the most common surgical procedures in childhood, post-tonsillectomy hemorrhage is not uncommon and occasionally life threatening. Although primary post-tonsillectomy hemorrhage that occurs within 24 hours of surgery is often caused by insufficient intraoperative hemostasis, delayed hemorrhage is frequently related to the rejection of wound surface and fibrinogen degeneration during wound healing. With the purpose of reducing postoperative pain and hemorrhage, intracapsular tonsillectomy was introduced. Intracapsular tonsillectomy has been shown to be superior to extracapsular tonsillectomy in terms of secondary hemorrhage. However, residual tonsillar tissues are left behind, and there are concerns about recurrent tonsillitis and regrowth of tonsillar tissues. In the present study, capsule-preserving surgery was performed only for the lower half of the tonsils. Because the arterial blood supply of the tonsils enters primarily at the lower pole, we hypothesized that combined intraand extracapsular tonsillectomy would be more advantageous than a single technique surgery, dramatically decreasing postoperative hemorrhage without recurrence.