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 sturdies 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 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. From case series, symptomatic improvement ranged from 40 to 98% (median, 88%). Conculsion: 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