Safety and efficacy of pediatric functional endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis

Abstract Objective The objective of this article is to evaluate the effectiveness and safety of pediatric endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis (CRS). Patients and methods This study was of a retrospective observational clinical type and was carried in the tertiary referral center. A total of 90 patients with CRS refractory to medical treatment and operated with endoscopic sinus surgery were included in this study. Computed tomography scan of the nose and paranasal sinuses was done for all patients. Sinonasal outcome test-20 German adapted version was used for preoperative and postoperative symptoms evaluation. Results Among these 90 children, there were 62 males and 28 females, with mean age of 12.5 (7–16) years. A total of 84 (93.3%) patients had CRS without nasal polyps, and CRS with nasal polyps was present in the remaining six (6.7%) patients. Nasal obstruction and purulent nasal discharge were the most reported symptoms. The follow-up period ranged from 6 months to 5 years, with a mean of 3.7 years. The overall success of the procedure was 68.8%. The most significant improvement was noticed by patients with nasal obstruction and purulent nasal discharge (90.3 and 88.8%). The least improvement occurred in patients with hyposmia (36.3%). Conclusion Functional endoscopic sinus surgery is a safe and effective procedure in children. Proper preoperative selection of patients is mandatory. Limited surgical intervention is needed in children with control of the disease and preservation of the nasal mucosa. Second-look operation may be needed in some cases. Follow-up is essential for success of the procedure

Traditional endonasal and microscopic sinus surgery complications versus endoscopic sinus surgery complications: a meta-analysis

The aim of this study was to compare the incidence of complications of endoscopic sinus surgery (ESS) to the incidence of complications of traditional and microscopic sinus surgery. A meta-analysis was carried out on 28 series of patients (a total of 13,405) who had undergone ESS, 8 series of patients (3,887 in total) who had undergone traditional endonasal sinus surgery and 7 series of patients (1,630 in total) who had undergone microscopic sinus surgery. The authors used the Bayesian inference package WinBUGS operating from within the statistical computer program R (version 2.7.1). Major complications had a higher incidence after traditional sinus surgery than ESS but this fact did not cause a significant statistical difference, whereas microscopic surgery had significantly more complications than ESS (p < 0.05). Carrying out our meta-analytic study, comparing major and minor complications of endonasal surgical approaches, was very difficult due to several methodological biases of data extraction and evaluation from studies concerning a broad timespan. Regarding major complications, we only found a significant statistical difference (p < 0.05) between the endoscopic (1%) and the microscopic methods (2.0%), but, if we had analyzed the data considering the natural learning curve of the latest ESS surgical approach, and if we had not considered the results produced in the first 10 years (1988-1998) concerning ESS in our meta-analysis, we would have found a statistically significant difference (p < 0.05) between the endoscopic (0.4%) and the traditional (1.1%) approach as well