Ban on re-using surgical tools lifted in tonsil operations

December 15, 2001 The Independent (London) by Lorna Duckworth
THE DEPARTMENT of Health ended a ban on re-usable surgical tools in tonsil operations yesterday, despite a "theoretical risk" of infecting patients with variant CJD, the human form of mad cow disease.

In a reversal of previous advice, surgeons were told they no longer had to use disposable instruments in tonsillectomies or adenoid operations.

The move followed an "alarming" increase in complications after surgery with the mass-produced, single-use instruments. Cases of haemorrhaging have doubled and last month one woman patient died at an unidentified English hospital. Ministers accepted yesterday that disposable instruments had resulted in too many "adverse events" and announced that surgeons could in future decide which type of instruments to use after consulting patients.

The British Association of Otorhinolaryngologists - ear, nose and throat surgeons - had demanded a halt to all non-urgent tonsillectomies until the problem was resolved.

The moratorium was demanded at two urgent meetings with the Department of Health this week, when a return to the old-style instruments was discussed.

Last night a Department of Health spokesman said: "We had to balance a tiny theoretical risk of vCJD from re-usable instruments with a different risk to patients from single-use instruments. We want doctors to discuss the balance of risk with patients and then decide."

About 6,500 operations to remove tonsils, mostly from children, are done each month. Normally, only a few patients suffer from bleeding in the days after surgery.

But earlier this year the Department of Health introduced disposable instruments for tonsillectomies after scientists said there was a "theoretical risk" of vCJD being spread by reusable surgical instruments.

The abnormal prion proteins linked to vCJD are not destroyed by conventional sterilisation so in theory they could survive on re-used instruments. There is also evidence that the prions have a predilection for the lymphatic system, having been found in the tonsil tissue of people who have died from the disease. The Department of Health suspended the use of single-use heat-sealing forceps earlier this month after the death of the female patient. It believes the actual danger of disposable instruments is more serious than the theoretical risk of re-usable ones.

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