Trans-nasal Endoscopic Sphenopalatine Artery Ligation in Epistaxis: Coblation Versus Electrocauterization
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ORIGINAL ARTICLE
Trans-nasal Endoscopic Sphenopalatine Artery Ligation in Epistaxis: Coblation Versus Electrocauterization Bhanu Bhardwaj1 • Jaskaran Singh2
Received: 29 July 2020 / Accepted: 31 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Epistaxis is one of the most common emergencies encountered by otorhinolaryngologist. Although anterior epistaxis is easy to manage but posterior epistaxis is usually refractory. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) is now a well established surgical technique for the management of refractory epistaxis. Electrocauterization and clipping are the most common methods used for ligation. Coblation is an upcoming tool with promising results in endoscopic skull base surgeries and tonsillectomies but has not been explored much in TESPAL. It was a randomised observational study.50 patients of refractory epistaxis were included in the study. The patients were divided into 2 groups. Group A underwent TESPAL using electrocauterization while Group B underwent TESPAL using coblation. The data was collected and analysed for various parameters like experience of the surgeon, time taken for surgery, episodes of rebleeding and postoperative crusting. Out of 50 cases in our study 27 were males and 23 were females. Most common age group was 60–70 years (68%). Most common cause was hypertension (86%). Surgeons were happy 21/25 times in coblation group compared to 9/25 times in electrocauterization group. There were 4/25 rebleeding episodes in electrocauterization group compared to none in coblation group. Post-operative crusting was also less in & Bhanu Bhardwaj [email protected] & Jaskaran Singh [email protected] 1
Sri Guru Ram Das University of Health Sciences, 27-C, Sant Avenue, The Mall, Amritsar, Punjab 143001, India
2
Sri Guru Ram Das University of Health Sciences, HIG 202, Sector 71, Mohali, Punjab 143001, India
coblation group compared to electrocauterization. Though electrocauterization is a well established method for TESPAL our experience with coblation in TESPAL has been extremely satisfying. We suggest our colleagues to conduct more research studies on use of coblation in TESPAL to reach a consensus. Keywords Epistaxis Refractory Posterior Endoscopic Sphenopalatine artery Ligation Coblation Electrocauteriztion Clipping
Introduction Lifetime incidence of epistaxis is about 60% and it is one of the most common emergency otolaryngologists encounter [1]. Most episodes of epistaxis are minor in severity and are self-limiting. Such bleeding usually originates from Kiesselbach’s plexus on the anterior nasal septum. Majority of the patients with epistaxis can be treated with chemical cauterization, hemostatic agent application and short-term application of anterior nasal packing, which are the first-line treatment methods. However, there is a group of patients with posterior epistaxis whose bleeding does not stop with these methods; though the incidence of such a bleeding is low (5–10%). Such severe episodes of
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