Daycase tonsil surgery – intracapsular tonsillectomy

Read our guide below to help you understand what to expect from your child’s tonsil surgery.

You can also download a PDF version of this patient information by following the link on the right.

What is an intracapsular tonsillectomy?

It involves removing the tonsil while leaving the tonsil capsule intact. This method protects the muscle underneath the tonsil meaning that fewer blood vessels and nerves are exposed.

An intracapsular tonsillectomy is less painful than a traditional tonsillectomy, with a reduced risk of bleeding after the operation. There’s also a shorter recovery period.

What are tonsils?

They’re small glands of lymphoid tissue at the back of the throat that may provide some protection from infection in very young children.

The body however has many more sophisticated ways of fighting infection. Young children who have their tonsils removed having their can still fight infections effectively.

From 3 years old, tonsils tend to shrink in size and are less important in fighting germs.

What are the benefits of the operation?

Removing the tonsils will help to solve :

• repeated or frequent tonsillitis. Your child may still develop a sore throat, but this won’t be tonsillitis
• obstructive sleep apnoea (OSA), a potentially serious sleep disorder causing breathing to stop and start during sleep.

We only remove tonsils if they’re doing more harm than good. Your child’s ear nose and throat (ENT) doctor will discuss this before an operation.

What are the risks?

This is a simple and safe operation, however, all operations carry some risks.

Less than 1 in every 100 children having intracapsular tonsillectomy will need to return to hospital because of bleeding, with a small proportion needing a second operation to stop the bleeding.

There’s a small risk of about 5 in 100 that your child may develop an infection after the operation. If an infection occurs, they’ll need antibiotics to treat it.

There’s also a small chance that the tonsils may regrow. This can affect 2 in 100 children who have an intracapsular tonsillectomy and it may result in another procedure or operation. This is more common if your child’s under 3 years old.

Are there any alternatives to a tonsillectomy?

Before we consider doing a tonsillectomy, we may try using frequent low dose antibiotics to help treat the infections. Or, we may use a low dose preventative antibiotic for a number of months to help keep infections away.

Children may also grow out of the problem of recurrent infections. We always wait at least a year before considering surgery.

Consent

We’ll ask for your written consent (agreement) for the operation to go ahead on the day of surgery. If you have any questions, please ask the doctor before signing the form.

Fasting instruction

Please follow the fasting (starving) instruction given to you with your appointment letter very carefully.

Fasting is very important before an operation. If your child has any food in their stomach whilst they’re under anaesthetic, it might come back up when they are asleep and cause your child to choke.

What happens during the operation?

The operation is carried out under a general anaesthetic. Your child will be asleep during the procedure.

The tonsils are then removed through the mouth. Any bleeding is stopped using cautery (an instrument used to seal a wound).

Your child will have the operation as a day case which means they’ll go home the same day. It’s rare, but sometimes your child may need to stay overnight if:

• they’re in a lot of pain after surgery
• there are any problems with bleeding after surgery
• there are concerns with your child’s breathing due to sleep apnoea.

For your child to go home on the same day as the operation you must also have:

• access to transport, for example a car or taxi and a phone in case of an emergency
• one adult carer per child who can stay with them at home for the first 24 hours.

Pregnancy statement

All girls over the age of 12 will need to have a pregnancy test before their operation or procedure. This is in line with our hospital policy.

We must make sure it’s safe to proceed with the operation. Many treatments including anaesthetic, x-rays or surgery carry a risk to any unborn child. The pregnancy test is a simple urine test with the results available immediately.

Anaesthetic risks

In modern anaesthesia, serious risks are uncommon but risks cannot be removed completely. Modern equipment, training and medicines have made it a much safer procedure.

Throughout life, an individual is at least 100 times more likely to suffer serious injury or death in a road traffic accident than as a result of anaesthesia.*

Most children recover quickly and are soon back to normal after their surgery and anaesthetic. The exact nature of the risks and potential complications depend on your child, their medical conditions and the surgery.

We discuss this in detail with you at your pre-operative visit and on the day of surgery.

What happens when I arrive at hospital?

We’ll ask you to arrive on the Children’s Day Care Ward on the morning of surgery. Your child’s nurse will show you to your child’s bed or waiting area.

The nurse will check the paperwork, put a name band on your child’s wrist, check their temperature, heart rate and breathing rate.

They’ll look after you and your child for the day, and prepare your child for the operation. They’ll make sure you understand the routine of the day and your child’s care before and after the operation.

Answering questions and consent

Our nurses will also answer any questions you or your child has.

The anaesthetist and surgeon will see you and your child on the ward. They’ll ask you to sign a consent form, discuss the procedure and answer any further questions you may have.

Cancelling surgery on the day of the operation

Very occasionally we may have to cancel the surgery on the day. This may happen if your child’s unwell or has active tonsillitis. Whilst we understand this may be disappointing, we do this beacuse the operation is more difficult and less safe when the tonsils are actively infected.

We wait for at least 2 weeks after the infection has cleared up before going ahead with the surgery.

What happens in the anaesthetic room?

A nurse and one parent or carer can accompany your child to the anaesthetic room. Your child may take a toy or comforter.

It may be possible to give the anaesthetic with your child on your lap. They may have gas to breathe or an injection through a cannula (a thin plastic tube that is placed under the skin, usually on the back of the hand).

Local anaesthetic cream (EMLA or Ametop, sometimes known as ‘magic cream) placed on the back of the hand before injections may reduce any pain. It works well in 9 out of 10 children.

If your child has anaesthetic by gas, it may take a little while for your child to become anaesthetised. They may become a little restless as the gases take effect.

An anaesthetic injection usually means your child falls asleep very quickly. Some parents find this upsetting.

Once your child is asleep, we’ll ask you to leave quickly so that the medical staff can concentrate on looking after your child. The nurse will take you back to the ward to wait for your child.

We’ll then take your child into the operating room to have the operation. The anaesthetist will be with your child at all times.

What happens after the operation?

Your nurse will take regular checks of your child’s temperature, heart rate and breathing rate.

They’ll also assess your child’s pain and make sure they have enough pain relief to keep them comfortable.

Once your child is awake enough after their anaesthetic, they can start to drink. If they do not feel sick they can then have something to eat.

Going home

We’ll monitor your child in the day care ward for at least 4 hours before they we allow them to go home. This is usually enough time for the nursing team to check your child is recovering well. It also gives us enough time to check your child can eat and drink normal food and pee.

Your child cannot go home on public transport after a general anaesthetic. You must take them home by car or taxi. This will be more comfortable for your child and make it quicker for you to return to hospital if there are any complications on the journey home.

What if my child feels sick or is being sick (vomitting)?

Occasionally the anaesthetic may leave your child feeling sick for the first 24 hours. The best treatment for this is small, frequent amounts of fluid and food such as toast or biscuits. If they continue to be sick for longer, contact your GP.

My child is unsettled, is this normal?

The hospital experience can be strange and unsettling for some children. Do not be concerned if your child is more clingy, easily upset or has disturbed sleep in the first few days after the operation.

Advice after an intracapsular tonsillectomy

It’s normal for your child’s throat to be sore after surgery. This can feel worse from days 3 to 5
after surgery but should start to get better daily after that.

Painkillers

We prescribe painkillers (paracetamol and ibuprofen) for your child to take regularly at home. They should take these regularly for the first 5 days after the operation. Painkillers can be given as needed after that. It is best to give the medicines half an hour before mealtimes to make eating and drinking more comfortable.

We do not normally give your child antibiotics to take home after surgery.

Eating and drinking

It’s essential your child eats and drinks normally. This helps the area at the back of the throat to heal. Foods such as toast, biscuits and crisps help the area at the back of the throat stay as clean as possible.

Common effects after the operation

It’s normal for their throat to have yellowish scabs at the back of the throat where the tonsils were removed.

Earache and bad breath are common for a few days after the operation. You may also notice your child snores for a few weeks until the area is healed and any swelling after surgery settles down.

It’s also normal for their nose to feel stuffy or ‘bunged up’.

Rest

Your child should rest as much as possible for the first few days and stay away from people with coughs and colds. This is to prevent infection.

They’ll need to have 1 week off school.

Please stay within your local area for 1 week in case your child develops any complications. Avoid foreign travel or flying for 3 weeks.

Complications

If your child has any serious bleeding after the operation through their mouth or nose when you get home, call 999 and ask for an ambulance.

Go to your nearest A&E department if your child has:

• a small or minor bleed through the mouth or nose
• a temperature of 38.5C or higher
• persistent pain which is not relieved by taking the regular prescribed doses of paracetamol and ibuprofen.

Follow-up care

It’s very unlikely your child will need a follow up appointment with the doctor. Your child’s surgeon or nurse will tell you on the day of surgery if your child needs an appointment.

If you have any concerns when you get home after your child’s surgery

Call the children’s day care ward on 01494 4225506.

You can also contact your GP.

If you think your child may be bleeding or has an infection, go to your nearest A&E department or call 999.

Helpful links

Tonsililectomy beacuse of repeated infections

Learn more about tonsillitis

Reference

*from ‘Your child’s general anaesthetic‘

Reducing associated healthcare infections

Find out how you can help to reduce healthcare associated infections when visiting hospital