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TITLE:

ENDOSCOPIC SINUS SURGERY FOR NASAL POLYPS: A LITERATURE REVIEW

AUTHORS:

Mohammed Majdi Toras , Ahmad Baker Aldajani , Abdulaziz Ahmad Abdullah Alshehri , Bashaier Gubran AlQahtani , Oula Hassan AL-shareef , Mona Nasser Solaim , Abdullah Suleiman Assalem , Mohammed Alaa Jamjoom , Marzouqi Abdulaziz Salamah, Ahmed Othman Abdullah Alshehri , Budur Hamad Alnefaie, Shatha Yahya Alqahtani , Khadija Yusuf Alansari , Saud Mohammad Hasan Alshehri, Sahira Jilan Al Nahari

ABSTRACT:

Background: Functional endoscopic sinus surgery (FESS) has been used for 30 years for the management of sinus disease including the excision of nasal polyps. Our objective was to perform a review of safety and effectiveness of FESS for the removal of nasal polyps. Methods: The Cochrane Library, MEDLINE, Embase, Science Citation Index, other databases, and websites were searched in January and December 2019 using key words for nasal polyps and endoscopic surgery. All randomized controlled trials, nonrandomized comparative studies, and case series studies that described outcomes associated with FESS for the excision of nasal polyps were included. Results: Three randomized controlled trials, 4 nonrandomized comparative studies, and 35 case series studies were included in the review. FESS was compared with endoscopic polypectomy, Caldwell-Luc, radical nasalization, and intranasal ethmoidectomy. In general, studies were of poor quality and lacked description of important variables influencing surgical outcome. The potentially most serious complications were cerebrospinal fluid leaks, injury to the internal carotid artery, dural exposure, meningitis, bleeding requiring transfusion, periorbital/orbital fat exposure, and orbital penetration. Symptomatic improvement ranged from 78 to 88% for FESS compared with 43 to 84% for comparative procedures. From case series, symptomatic improvement ranged from 40 to 98% (median, 88%). Conclusion: FESS may offer some advantages in safety and effectiveness over comparative techniques, but wide variation in reported results and methodological shortcomings of studies limit the certainty of these conclusions. Wide variation in complication rates suggests the need for audit of existing practice. Additional high-quality studies with a fuller description of potential confounding factors and effect modifiers will help to define the effectiveness of FESS more clearly. Keywords: Endoscopic Sinus Surgery, Nasal Polyps, Safety, Review.

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