Outcomes of endoscopic ethmoidectomy performed on a day-case basis: a prospective bi-centric study.

Evaluation of endoscopic ethmoidectomy performed as a day-case in terms of security, quality, and satisfaction of the patient. This prospective observatory bi-centric study over 1 year included 74 patients undergoing an ethmoidectomy respecting the eligibility criteria of ambulatory care. We recorded patients' demographic data, operative details, satisfaction, postoperative course, and follow-up results. Nasal symptoms were evaluated by SNOT-22 on preoperative appointment and postoperatively at D30. No non-absorbable nasal packing was used, eventually in the case of preoperative-bleeding absorbable gelatine packing. The postoperative follow-up took place at D1 by phone call and at D10 and D30 to assess complications, Visual Analogue Scale, and state of ethmoidal corridors by endoscopic exam. Patients benefited of bilateral ethmoidectomy in 82.4 % cases associated with septoplasty in 42 %. The majority (95 %) was discharged on the same day. Only one patient had bleeding at D0 and was kept in standard hospitalization, such as three other patients for medical or organizational reasons not related to surgery. At D1, 23 % described postoperative light bleeding but needed no revisit and pain was estimated at 1.3 (VAS). No readmission was observed, and no major complication was noted. SNOT-22 decreased successfully by 56 %, statistically related to postoperative treatment of corticosteroids and in the case of Samter triad. 97 % of patients were satisfied of the ambulatory care. These results suggest that within an experienced and dedicated day-case medical and paramedical team, ethmoidectomy can be safely performed on a day-case basis with high quality of taking care and satisfaction of patients.

Surgical Instructions in Revision Endoscopic Sinus Surgery: Pearls and Pitfalls.

Functional endoscopic sinus surgery (FESS) has become one of the most common surgical techniques performed by otolaryngologists with significant data demonstrating its efficacy in managing patients with chronic rhinosinusitis (CRS). However, despite this initial success, patients may continue to present with recurrent symptoms and approximately 10-15% of them will require revision surgery. Failure of FESS may have many different causes which include inappropriate patient selection and preparation, comorbidities like cystic fibrosis and Samter's triad, insufficient surgical skills or anatomical variations that have not been addressed adequately. Two inverse European techniques were introduced in the 1980s. The one promoted by Messer-klinger, who practiced the anterior-to-posterior approach, another one, developed by Wigand who performed posterior-to-anterior dissection, opens the sphenoid ostium or removes the anterior wall of the sphenoid sinus and ends with a total ethmoidectomy. Hereby in RESS we start dissection in posterior-to-anterior fashion by following a structured approach in the identification of the fixed landmarks to allow quick and easy orientation to the skull base and medial orbital wall to avoid the complications.