Postoperative outcome of palatine tonsillectomy by tonsil pillar suture with knot-free suture.

Background: Postoperative haemorrhage following palatine tonsillectomy occurs in 5-14% of cases. Since 2021, our department has used knot suturing with 3-0 Vicryl, and from 2023, continuous suturing with the V-Loc^™ closure device to reduce suture time. While knot suturing is reported to reduce postoperative bleeding and pain, no studies have compared outcomes between different suture methods.

Aims: This study retrospectively analysed postoperative bleeding, pain, and complications in 125 patients undergoing palatine tonsillectomy, with or without sutures.

Methods: Patients aged ≥15 years who underwent bilateral tonsillectomy from October 2019 to March 2024 were grouped into no-suture, knot-suture, and knot-free-suture categories. Data on operative time, pain, bleeding, suture dissection, and complications were compared using the Mann-Whitney U test for continuous variables and the chi-square test for nominal variables.

Results: Knot-free sutures had the shortest operative time (53 ± 16 min) compared to no sutures (62 ± 19 min) and knot sutures (94 ± 22 min). Pain decreased over time across all groups. Bleeding rates were similar, though knot-free sutures required frequent removal (76%). Knot sutures had a significantly lower dissection rate (<0.001).

Conclusions and significance: Knot-free sutures improve surgical efficiency but may require additional postoperative interventions, representing a cost-effective alternative to high-energy devices.