Larin Stiller-Timor

Soroka University Medical Center, Israel

Title: Circulating cytokines in patients undergoing tonsillectomy with fibrin glue



Objective: Fibrin glue is used as a haemostatic agent or as a sealant. The aim of this study is to objectively evaluate the efficacy of the use of fibrin glue Quixil – a human surgical sealer – in tonsillectomy, for the reduction of post-operative inflammatory response. Study design: A prospective randomized single-blind study. Methods: The study was performed on 40 consecutive patients undergoing adenotonsillectomy (T&A). Patients were randomly assigned to one of two sub-groups: a study group and a control group. The tonsillar beds of patients in the study group were coated with fi brin glue (Quixil, OMRIX biopharmaceuticals) at the end of the operation; the patients in the control group were treated for hemostasis without the use of fi brin glue. Complete blood counts and circulating pro-infl ammatory cytokines (assayed by specifi c immunoassay – ELISA) were assessed in samples drawn pre- and 16 hours post-tonsillectomy. Results: Forty patients (aged 5.8±2.4 y) were consecutively enrolled; 45% (18) of the patients were treated with fi brin glue, 55% (22) were not. Compared to controls, Quixil-treated patients demonstrated a reduction in post-tonsillectomy circulating leukocytes (29.2% vs. 45.4%, p<0.05), neutrophiles (28.3% vs. 42.1%, p<0.05), IL-6 (+1% vs. +42%, p<0.05), and TNF-alpha (+8% vs. +26%, p<0.05. Conclusions: Intra-operative fi brin glue therapy is associated with decreased immediate infl ammatory response following T&A. Further studies are warranted to assess long term outcome. Level of evidence: 1B