Objectives: To investigate the long-term effect of childhood guillotine tonsillectomy without anesthesia on human mental and physical state.
Materials and Methods: Forty-nine adults with childhood guillotine tonsillectomy were selected for health-check 30 years after the surgery. 49 non-surgical cases were randomly  selected as a control group. Participants were required to complete a self-reporting inventory (SCL-90). The psychological status of the surgical group was also investigated. In  addition, electrocardiogram (electrocardiogram, ECG), chest radiograph, abdominal B ultrasound, liver and kidney function, routine blood test, blood glucose and blood lipids were  included in Health-check. 
Results: There was no statistical difference between scores of SCL-90 in surgery group and control group (p > 0.05). The results of psychological survey showed that childhood  guillotine tonsillectomy won’t affect the long-term psychological status of children. There was no significant difference between surgery group and control group in Health-check (p  > 0.05).
Conclusion: Childhood guillotine tonsillectomy without anesthesia will not exert a long-term impact on the children.

Guillotine tonsillectomy; Childhood; Psychological; Physical; Follow-up study

Sun W, Wu L, Zhuang H, Zhu X (2020) Mental and Physical Health Observation on Guillotine Tonsillectomy without Anesthesia: A 30-Year Follow-Up Study. Ann Otolaryngol Rhinol 7(3): 1242.

Tonsillectomy (tonsillectomy, TE) is one of the oldest and most common operations still performed today [1]. There are a variety of TEs: blunt dissection; guillotine excision; cryosurgery; monopolar and bipolar diathermy dissection; bipolar scissor dissection; microscopic bipolar diathermy dissection; ultrasonic removal; and laser dissection [2]. All these operations have their own advantages and disadvantages.

Among all these TEs, carefully-selected children guillontine TE without anesthesia is a safe, time-saving and economical procedure [3,4]. However, psychological problems caused by guillotine tonsillectomy on children ithout anesthesia remain unclear. Short-term follow-up studies reported that there are no psychological side effects on the children [3-7]. However, longterm follow-up studies concerning the psychological side effects on the children are lacking.

To the authors’ knowledge, this is the first study of a longterm investigation on the psychological status of 49 individuals after they received a guillotine tonsillectomy without anesthesia in their childhood. The main aim of this study, which lasted for over 30 years, was to evaluate the mental and physical impact of guillotine tonsillectomy without anesthesia in the long run.

During the investigation, forty-nine people who received guillotine tonsillectomy without anesthesia in their childhood (> 30 years ago) were selected as the surgical group and 49 people of the same age and sex, who have not received any operation of the same sort, were selected as the control group. The surgical group consisted of 27 women and 22 men (median: 50 years; age interval 35-63). At the time of surgery, they had a median age of 8 years old (age interval5 years to 14 years).

All of these 98 people were required to complete a selfreporting inventory (SCL-90) in order to assess their psychological status. Additionally, the participants were also scheduled to have a complete physical examination at the Health Center of the First Affiliated Hospital of Sun Yat-Sen University. With the approval of the Ethics Committees at the First Affiliated Hospital of Sun Yat-Sen University, informed consent was obtained for this study.

he following questionnaire is designed to assess patient attitudes to childhood guillotine tonsillectomy. The content of subjective feeling questionnaire is shown in Table 1.

Table 1: The questionnaire is designed to assess patient attitudes to tonsillectomy.

All people who came to the health center of Sun Yat-Sen university first affiliated hospital in 2011 were asked to complete questionnaires. The survey results were then consolidated and analyzed. In addition, participants were required to complete a self-reporting inventory (SCL-90) after consent was obtained.

EXAMINATION The venous blood samples were first used for routine blood test by using fully automatic cell counter (Hema-screen 18, HOSPITEX DIAGNOSTICS s. r. l, Italy). The blood test indicators examined in the tests are white blood cell count, red blood cell count, hemoglobin and platelet count. After the routine tests, the serum was extracted from a new set of blood samples for examinations on liver and kidney function, blood glucose, and blood lipids using automatic biochemical analyzer (Hitachi 7060Hitachi Industrial Co, Ltd. Japan).

During the tests, the serum alkaline phosphatase (ALP), aspartate transaminase (AST) and gamma-glutamyl transaminase (GGT) of blood samples were recorded as indices of hepatic function. Serum creatinine (Scr), urea nitrogen (BUN), and uric acid were recorded to assess renal function. Serum total Cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL-C), and high-density lipoprotein (HDL-C) were used as indices of blood lipids.

All the data were stored in a database and then analyzed using SPSS software (SPSS, Windows, version 13). Chi-squared tests (Crosstas) were used to compare all the examination results of the surgical and control group, which include the results of electrocardiogram, chest radiograph and B ultrasonic of abdomen. Despite that, the data of liver and kidney function test; blood routine test; blood sugar and lipids test and the scores of SCL-90 were analyzed using independent samples t test. p < 0. 05 were considered to be statistically significant.

Scores of SCL-90 in guillotine tonsillectomy group and control group

All 49 cases had no psychological problem 30 years after the operation. As shown in Table 2,

Table 2: Scores of SCL-90 in tonsillectomy group and control group.

no significant differences in the psychological status (SCL-90) were found between guillotine tonsillectomy group and control group.

Outcomes of subjective assessments

47 of 49 cases (96%) who underwent childhood guillotine tonsillectomy were satisfied and one of 49 cases (2%) complained that the surgery was unsuccessful. The rest of the group (2%) complained of voice change. Among the participants who had received childhood guillotine tonsillectomy 30 years ago, the surgery had no negative impact or almost none on their daily activities in 41% cases and the most uncomfortable phenomenon caused by the surgery was the postoperative throat pain within 48 hours in 49% cases. 6% cases said that the most uncomfortable thing was intraoperative sore throat while 2% cases implied that intraoperative guillotine pull and traction was the most unbearable. As for the rest (2%), they wrote in the report that the worst thing about the operation was postoperative eating difficulties.

Guillotine tonsillectomy group and control group ECG, chest radiograph and abdominal ultrasound results

The results of ECG, chest radiograph and abdominal ultrasound of childhood guillotine tonsillectomy group and control group are shown in Table 3.

Table 3: Tonsillectomy group and control group ECG, chest X-ray and abdominal ultrasound results of the comparison (units; cases).

There were no significant differences in ECG, chest radiograph and abdominal ultrasound results between childhood guillotine tonsillectomy group and control group (p = 1.00; p = 0.11; p = 0.53).

The test results of the guillotine tonsillectomy group and the control group on blood routine, blood glucose, liver and kidney function and blood lipids

The test results of childhood guillotine tonsillectomy group and control group on blood glucose, liver and kidney function and blood lipids is shown in Table 4.

Table 4: Results of Tonsillectomy group and control group: blood, glucose, liver and kidney function and blood lipids

These results did not imply any significant difference between the operation and control groups. Routine blood (white blood cell count, red blood cell count, hemoglobin and platelet count) test results did not show any significant difference between the operation and control groups (t = -1.340, p = 0.183; t = 0.066, p = 0.947; t = -0.461, p = 0.646; t = 0.685, p = 0.495). Neither did the results of the liver function tests (ALP, AST and GGT) (t = -1.535, p = 0.128, t = -1.522, p = 0.131, t = -1.424, p = 0.158). Fasting blood glucose and renal function tests (Bun, Scr and Uric acid) did not show any significant difference between the operation and control groups (t = -1.158, p = 0.250, t = 0.418, p = 0.677, t = 0.171, p = 0.864, t = -1.391, p = 0.168) and the blood lipids (Chollipidsol, Triglycerides, HDL-C and LDL-C) test results implied no significant difference between the operation and control groups (t = 0.823, p = 0.413, t = 0.067, p = 0.946, t = -0.094, p = 0.926, t = 0.629, p = 0.531).

In this study, we identified the psychological status in 49 adults who have received guillotine tonsillectomy in their childhood without anesthesia. We found that the psychological status of the people who had guillotine tonsillectomy without anesthesia in their childhood quite ordinary after 30 years. This is to say, this particular surgery will not exert a long-term impact on the children, according to the results.

The psychological problems were even relatively less reported after childhood guillotine tonsillectomy. Under local anesthesia, none of 401 families confessed to psychologic problems in their children, three years after guillotine tonsillectomy [8]. Pediatric otolaryngology textbooks suggest that psychologic needs before and after tonsillectomy usually can be required attention [9].

Post-tonsillectomy morbidity can occasionally manifest with depressive symptoms, usually resolving spontaneously. No children had persisting depressive symptoms 3 months later [7]. Tonsillectomy itself does not have a harmful effect on children’s psychological status at 3 weeks after surgery [10]. In the present study, selected parameters of the psychological and physical health status of 49 children 5-14 years after guillotine tonsillectomy were compared to those of 49 age-matched and sex-matched non-tonsillectomized adults. Our study showed that scores of SCL-90 did not show any significant difference between the operation and control groups. This directly showed that childhood guillotine tonsillectomy won’t affect the psychological status in the long run. In addition, the questionnaire results showed that all of 49 cases had no psychological problem after the operation. 47 of 49 cases (96%) who underwent childhood guillotine tonsillectomy were satisfied. This indirectly showed that childhood guillotine tonsillectomy won’t affect the long-term psychological status of children. Furthermore, the questionnaire results showed that the most uncomfortable phenomenon for a child who had received guillotine tonsillectomy were postoperative throat pain within 48 hours (49%) and only 6% of the participants mentioned the intraoperative pain. This directly shows that childhood guillotine tonsillectomy without anesthesia is of no significant difference from one with anesthesia in terms of cruelty, considering the most uncomfortable part of the operation is the postoperative pain [2].

In addition, our study showed that the parameters of the physical health status (ECG, chest radiograph, abdominal ultrasound, blood, glucose, liver and kidney function and blood lipids) did not show any significant difference between the operation and control groups. This also indirectly implied that childhood guillotine tonsillectomy will not affect the health status after 30 years. Our results are different from those of a previous study of 18 patients twenty years after surgery [10]. In our studytonsillectomy-group, there is no significant difference between the results of ECG, chest radiograph, abdominal ultrasound, blood, glucose, liver and kidney function and blood lipids of the guillotine tonsillectomy group and the comparison group. One possible reason for this discrepancy may be the difference in selecting the participants. In a word, according to our study, childhood guillotine tonsillectomy will not cast a shadow on long-term (> 30 years ago) psychological and physical health. In agreement with the findings of Broekman and Andreou [6,11], tonsillectomy is likely to improve patients’ physical and general health.

This is, according to our knowledge, the first retrospective study of mental and physical health observation 30 years after childhood guillotine tonsillectomy. The main defects of this study are the retrospective analysis and the small cohort (49 cases). However, this study still has some points that the doctors can refer to during clinic practice. First, according to our study, guillotine tonsillectomy without anesthesia will not affect the psychological status of the patients in the long run. Secondly, guillotine tonsillectomy without anesthesia takes only one or two minutes, which is much shorter than one with anesthesia. The last point is that guillotine tonsillectomy without anesthesia will eliminate the possible side effects of anesthesia.

Childhood guillotine tonsillectomy without anesthesia will not exert a long-term impact on the children, both in psychological and physical status. Childhood guillotine tonsillectomy without anesthesia is feasible and acceptable.

This work was supported by the National Natural Science Foundation of China (grant number 81602365), Natural Science Foundation of Guangdong Province (grant numbers 2014A030313031, 2016A030310153).

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