Embolization in the management of recurrent secondary post-tonsillectomy haemorrhage in children.

Objectives: The purpose of this study was to evaluate the clinical efficacy and safety of endovascular treatment (EVT) compared with iterative surgery (IS) in paediatric patients with secondary post-tonsillectomy haemorrhage (PTH) refractory to surgical haemostasis (SH).

Methods: We retrospectively identified 424 consecutive children with secondary PTH. PTH ceased spontaneously in 215 patients, but SH was required in the remaining patients, failing in 15 cases. In these 15 children, we analyzed the benefit of EVT by comparing the outcomes of the nine patients who underwent IS with the six children who underwent an EVT.

Results: After a first attempt at surgical haemostasis failed, the success rate of additional surgical procedures was 50% for the second procedures (6/12) and 67% (2/3) for the third. Conversely, EVT was always successful, even though no vascular source of bleeding was found in any patient. EVT did not elicit any complications. Moreover, it tended to reduce the hospitalization duration and the number of red blood cell transfusions.

Conclusions: In the event of failure of the first attempt at surgical haemostasis in the presence of secondary PTH, our study suggests that in most instances, endovascular treatment is preferred to iterative surgical haemostasis, even if no vascular source of bleeding is found.

Key Points: • In recurrent secondary post-tonsillectomy haemorrhage, the rate of success declined with additional surgery. • Endovascular treatment was always successful and did not elicit any complications. • Embolization was useful even if no source of bleeding was found. • Embolization tended to reduce hospitalization duration and red blood cell transfusions. • Embolization may be considered as an alternative option to iterative surgery.