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Tonsillectomy and Appendectomy

Tonsillectomy and Appendectomy

“We’re going to need to take that out.”

If you have heard those dreaded words uttered by a physician, your first thought probably was, “Don’t I need that?” Truth is, often you don’t.

The term “-ectomy” is a surgical suffix referring to the removal of something and stems from the Greek “ek” (out) plus “tome” (a cutting). Whether the something in question is an achy appendix or a pair of troublesome tonsils, patients undergoing such procedures often find themselves questioning the necessity of body parts deemed not long for this world.

todd huberOne of the frequent procedures performed in the United States is the tonsillectomy. Otolaryngologist Todd Huber, M.D., of Vanderbilt Ear, Nose and Throat in Franklin, says the tonsils, composed of the same tissues as the lymph nodes in the neck, are a very small part of the body’s immune system.

“Tonsils are designed to trap and fight infections,” Huber says. “Large tonsils more easily trap bacteria in surfaces and pits, causing infection. Recurring infections result from bacterial colonization, which is difficult if not impossible to eradicate without removing the tonsils completely.”

Huber says today’s medical criteria for tonsillectomy is very specific compared to those of years past.

“From the 1940s through the 1960s, nearly everyone had their tonsils removed at the first sign of a sore throat,” he says. “There wasn’t much good research on it.”

As research has progressed, Huber says the number of tonsillectomies performed has struck an appropriate balance. Today, the decision to perform the surgery is determined by the level of obstruction or the frequency of infections such as strep throat. He says the general rule is seven infections in one year, five a year for two years, or three a year for three years or more.

He also says the operation, which generally lasts no more than 15 minutes, is as safe for adults as it is for children.  

“While the safety equivalent is the same, the degree of pain usually is more severe in patients over age 12 years,” Huber says, citing the maturation of the nervous system as cause. Fortunately, today’s tonsillectomy generally is less painful than those performed years ago, thanks to newer techniques such as Coblation.

Another myth Huber often hears from patients is that people without tonsils are more prone to infection than those with tonsils. While viral infections still are possible, he says research shows no such increase.

So how does the body continue to thrive after a tonsillectomy?

“When tonsils reach a point to where they need to be removed, they’re doing more harm than good anyway,” Huber says.

Like the tonsils, the appendix also comprises a small part of the body’s immune system and is hardly missed once removed.

“The appendix participates in the immune system by making lymphocytes, which are found in white blood cells and fight infections,” says Bernard Burgess, M.D., F.A.C.S., of Franklin Surgical Specialists.

Normally the size of a worm, the appendix is located on the right side of the body at the beginning of the large intestine.

“When the opening to the appendix becomes obstructed, pressure builds up and the appendix swells,” Burgess says. “When infected, it can become the size of a finger.”

Appendicitis, or infection of the appendix, is fairly common, affecting one in 15 Americans. Although it can strike at any age, appendicitis is rare under age 2 and most common between ages 10 and 30. Classic symptoms include dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen, loss of appetite, nausea or vomiting soon after abdominal pain begins, abdominal swelling, fever and the inability to pass gas.

Appendectomy typically is performed through laparoscopy, which requires a small incision in the lower right side. Patients generally have a short hospital stay of one to two days, Burgess says, and return to normal activities within two to three weeks.

Today’s tonsillectomy patients can expect a quick surgery followed by a comparatively fast recovery. Even two or three weeks of post-surgery couch time doesn’t seem so bad considering the primitive and not-so-sterile techniques once used by our ancestors.

The first recorded extraction of the tonsils took place in Rome in 40 A.D. The method preferred by physicians of the day involved blunt removal using the finger, a technique believed to be more effective than instruments, which would cut off only part of the tonsil. The technique was used for centuries before being dismissed because of hygienic concerns. In the early1800s, an American created guillotine snares intended to help general surgeons perform the operation as quickly as possible, especially in children, as it was not yet possible to sustain general anaesthesia for a long period of time.

By the end of the 19th century, the procedure predominately was performed by ear, nose and throat specialists (otolaryngologists). Over the past several decades, tonsillectomy methods have included the cold technique — using a scalpel to cut the tonsil tissue out — and electrocautery, which uses heat to decrease blood loss during surgery. Despite electrocautery’s advantages, the technique can damage nearby tissue and increase post-operative pain, causing many otolaryngologists to favor coblation electrosurgery to remove tonsils and adenoids. Instead of charring or burning, coblation uses radiofrequency energy with a natural saline solution to remove tonsils and adenoids while sealing blood vessels and protecting surrounding tissue.

Source: the National Library of Medicine and the National Institutes of Health.