Outpatient Treatment of Post Endoscopic Sinus Surgery Adhesions: How We Do It

Abstract

Objectives:

The formation of intra-nasal adhesions following endoscopic sinus surgery (ESS) is a well-known cause of surgical failure. These arise from raw wound edges resulting in progressive nasal obstruction and leading to closure of recess openings. Many publications discuss various intra-operative nasal packing or hemostatic agents with regard to post-operative hemostasis and wound healing but not affecting adhesion formation. The difficulty lies with maintaining airway patency post-operatively, as adhesion recurrence rate is high.

Methods:

A retrospective study on all patients operated by the authors who had ESS for chronic sinusitis or nasal polyposis between January 2011 and December 2011 revealed 16 nasal cavities that developed post-operative intra-nasal adhesions. Adhesiolysis was performed under local anesthesia in the outpatient department. Gelfoam was placed over the raw edges as a hemostatic aid and to avoid reformation of adhesions. This was repeated weekly until the edges healed.

Results:

All patients (100%) were treated successfully with no adhesion recurrence after 6 months. The longest outpatient treatment was for 8 weeks with the mean at 5 weeks.

Conclusions:

Adhesions are well known complications following ESS reducing surgical efficacy. Repeated surgeries for adhesiolysis are usually unsuccessful, as recurrences are common. This is the first study describing the use of Gelfoam for treatment of post-operative intra-nasal adhesion formation with 100% success rate and no recurrences. This can be easily performed under local anesthesia in the outpatient setting. This avoids unnecessary inpatient admissions or the risk of general anesthesia, providing safer and better quality care for patients.