Gelatin-thrombin matrix-mediated hemostasis: application in tonsillectomy

Background: To assess the feasibility of omitting thermal coagulation following cold knife tonsillectomy, we compared the use of a local thrombin hemostat (FloSeal®, FS) to bipolar electrocautery (EK).

Methods: A total of 181 patients with chronic tonsillitis or tonsillar hypertrophy were stratified in terms of patient characteristics and randomized before undergoing tonsillectomy. The follow-up period continued until postoperative day 20.

Results: FS-treated patients reported lower postoperative pain intensity scores (p = 0.011) and significantly reduced pain duration (p < 0.001). Whilst wound healing appeared to be improved in FS patients, the rates of postoperative hemorrhage remained unchanged. Use of an FS enabled inexperienced surgeons (< 100 procedures) to reduce their operating time by 8 min (p = 0.05), although no effect was observed for experienced surgeons.

Conclusions: Hemostasis is effectively mediated by an FS and its application reduces postoperative pain intensity and duration. Although we observed accelerated wound healing and reduced operating times owing to a more calculable rate of hemostasis, this did not influence the rates of postoperative hemorrhage.