Análisis y resultados de la cirugía endoscópica nasosinusal en rinosinusitis crónica con pólipos / Analysis and results of endoscopic sinus surgery in chronic rhinosinusitis with polyps

Introducción y objetivos. Actualmente la cirugía endoscópica nasosinusal es el procedimiento quirúrgico de elección en los casos de poliposis nasosinusal refractaria al tratamiento médico. El objetivo de este estudio es mostrar nuestra experiencia en el manejo de dichos pacientes intervenidos mediante cirugía endoscópica nasosinusal. Método. Estudio retrospectivo de 246 pacientes con rinosinusitis crónica con pólipos intervenidos mediante cirugía endoscópica. Estudiamos las características de la población, síntomas, grado de afectación, complicaciones y recidivas. Resultados. La comorbilidad más frecuente es el asma (34,6%) y su relación con la tríada de Samter (16,3%). Prevalecen los grados 2 y 3 de poliposis según la estadificación de Lildholdt por nasofibroscopia coincidiendo con la estadificación radiológica prequirúrgica. El microdebridador no supone acortamiento del tiempo quirúrgico pero sí disminución de las complicaciones. La reducción de la estancia media con el uso de hemostáticos absorbibles y su eficacia en el control de la hemostasia es estadísticamente significativa. Se describen 23,2% de complicaciones; solo una (0,4%) es una complicación mayor, siendo el resto complicaciones menores, de las que la sinequia es la más frecuente (16,3%). Conclusión. La cirugía endoscópica nasosinusal es una técnica mínimamente invasiva y segura. Los hemostáticos absorbibles son un método alternativo eficaz para obtener una completa y estable hemostasia disminuyendo la estancia media hospitalaria. Las sinequias continúan siendo las complicaciones más frecuentes, y el hecho de que muchos pacientes intervenidos recidiven, pero sin complicaciones, habla en favor de una evolución natural de la enfermedad y no de la influencia de la técnica (AU)

Introduction and objectives. Endoscopic sinus surgery is currently the surgical procedure chosen in cases of sinonasal polyposis refractory to medical treatment. The aim of this study was to show our experience in managing such patients operated using endoscopic sinus surgery. Method. A retrospective study of 246 patients with chronic rhinosinusitis and nasal polyps who were operated by endoscopic surgery. We studied the characteristics of the population, symptoms, grade of affectation, complications and recurrences. Results. The most frequent comorbidity was asthma (34.6%) and its relationship with Samter's triad (16.3%). Grades 2 and 3 polyposis prevailed according to Lildholdt staging by nasofibroscopy, coinciding with the radiological preoperative staging. The microdebrider did not shorten surgical time but it lowered complications. Reducing the average stay with the use of absorbable haemostatic agents and their effectiveness in controlling hemostasis were statistically significant. We found 23.2% complications, with only one (.4%) being a major complication; the rest were minor complications, with synechiae as the most frequent (16.3%). Conclusion. Endoscopic sinus surgery is a minimally invasive and safe technique. Absorbable haemostatic agents are an effective alternative to get complete and stable hemostasis, reducing mean hospital stay. Synechiae continue being the most frequent complication. The fact that many patients recurred but without complications speaks in favour of a natural evolution of the disease and not of the influence of technique (AU)

Analysis and results of endoscopic sinus surgery in chronic rhinosinusitis with polyps. / Análisis y resultados de la cirugía endoscópica nasosinusal en rinosinusitis crónica con pólipos.

INTRODUCTION AND OBJECTIVES: Endoscopic sinus surgery is currently the surgical procedure chosen in cases of sinonasal polyposis refractory to medical treatment. The aim of this study was to show our experience in managing such patients operated using endoscopic sinus surgery. METHOD: A retrospective study of 246 patients with chronic rhinosinusitis and nasal polyps who were operated by endoscopic surgery. We studied the characteristics of the population, symptoms, grade of affectation, complications and recurrences. RESULTS: The most frequent comorbidity was asthma (34.6%) and its relationship with Samter's triad (16.3%). Grades 2 and 3 polyposis prevailed according to Lildholdt staging by nasofibroscopy, coinciding with the radiological preoperative staging. The microdebrider did not shorten surgical time but it lowered complications. Reducing the average stay with the use of absorbable haemostatic agents and their effectiveness in controlling hemostasis were statistically significant. We found 23.2% complications, with only one (.4%) being a major complication; the rest were minor complications, with synechiae as the most frequent (16.3%). CONCLUSION: Endoscopic sinus surgery is a minimally invasive and safe technique. Absorbable haemostatic agents are an effective alternative to get complete and stable hemostasis, reducing mean hospital stay. Synechiae continue being the most frequent complication. The fact that many patients recurred but without complications speaks in favour of a natural evolution of the disease and not of the influence of technique.