Patient Selection, Counseling Can Prevent FESS Failures, Disappointments

Dr. Sillers stressed that postoperative care may include appropriate early debridements in follow-up care, as well as ongoing medical therapy. These are important and can improve successful outcomes, he said. The physician needs to have the proper equipment, such as sinuscopes, to confirm that the sinuses are patent as they were at the time of surgery.

Inadequate postoperative care can result in three problems: lateralization of the middle turbinates, synechiae formation, and stenosis of the frontal recess, Dr. DelGaudio said. Postoperative medical or procedural interventions can include oral or topical steroids to address postoperative edema, dilation of the sinuses, and removal of scar tissue. The key is to recognize the postoperative events on which the surgeon can intervene and improve outcomes, he said.

Treatment after FESS Failure

After FESS failure, the next step may be either revision surgery or a change in medical therapy. The treating physician may not have tried certain medications before surgery, Dr. Senior said. Maybe more aggressive allergy treatment is appropriate, or an investigation into the patient’s immune system if the surgery does not result in some improvement.

If revision surgery seems to be appropriate, surgeons should proceed, he said. Fortunately, 80% to 90% of well-selected patients will get some significant benefit from revision surgery, he said.

In Dr. Kountakis’s practice, nasal endoscopy and sinus CT are used to formulate an individualized plan for revisions. Recurrent polyps are removed to reduce the mucosal inflammatory load and improve sinus ventilation and anatomic obstruction or problems are corrected. You can’t just go in and try to do revision surgery without understanding why primary surgery failed, he said.

Reference

1. Kountakis SE, Arango P, Bradley D, Wade ZK, Borish L. Molecular and cellular staging for the severity of chronic rhinosinusitis. Laryngoscope 2004;114:1895-1905.
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