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European Archives of Oto-Rhino-Laryngology

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01-12-2016 | Review Article

How effective is postoperative packing in FESS patients? A critical analysis of published interventional studies

Authors: Petros V. Vlastarakos, Emily Iacovou, Melina Fetta, Marios Tapis, Thomas P. Nikolopoulos

Published in: European Archives of Oto-Rhino-Laryngology | Issue 12/2016

Abstract

The present study aimed to assess the clinical effectiveness of absorbable packing alone, non-absorbable packing alone, and absorbable versus non-absorbable packing in the postoperative care of FESS patients, regarding bleeding control, adhesion formation, wound healing, and overall patient comfort. Systematic literature review in Medline and other database sources until July 2013, and critical analysis of pooled data were conducted. Blinded prospective randomized control trials, prospective, and retrospective comparative studies were included in study selection. The total number of analyzed studies was 19. Placing packs in the middle meatus after endoscopic procedures does not seem to be harmful for postoperative patient care. Regarding the postoperative bleeding rate, absorbable packing is not superior to no postoperative packing (strength of recommendation A). Comparing absorbable to non-absorbable packing, the former one seems slightly more effective than the latter in the aforementioned domain (strength of recommendation C). Absorbable packing was also found more effective than non-absorbable packing as a means of reducing the postoperative adhesion rate (strength of recommendation B), and more effective in comparison with not placing any packing material at all (strength of recommendation C). Non-absorbable packing also proves more effective than no postoperative packing in preventing the appearance of such adhesions (strength of recommendation A). Absorbable packing is also more comfortable compared to non-absorbable materials (strength of recommendation A), or no postoperative packing in FESS patients (strength of recommendation B). The comparative analysis between the different packing modalities performed in the present study may help surgeons design a more individualized postoperative patient care.

Fokkens WJ, Lund VJ, Mullol J et al (2012) EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012: a summary for otorhinolaryngologists. Rhinology 50(1):1–12PubMed

Pomerantz J, Dutton JM (2005) Platelet gel for endoscopic sinus surgery. Ann Otol Rhinol Laryngol 114(9):699–704CrossRefPubMed

Franklin JH, Wright ED (2007) Randomized, controlled, study of absorbable nasal packing on outcomes of surgical treatment of rhinosinusitis with polyposis. Am J Rhinol 21(2):214–217CrossRefPubMed

Kastl KG, Betz CS, Siedek V, Leunig A (2009) Control of bleeding following functional endoscopic sinus surgery using carboxy-methylated cellulose packing. Eur Arch Otorhinolaryngol 266(8):1239–1243CrossRefPubMed

Kastl KG, Betz CS, Siedek V, Leunig A (2009) Effect of carboxymethylcellulose nasal packing on wound healing after functional endoscopic sinus surgery. Am J Rhinol Allergy 23(1):80–84CrossRefPubMed

Leunig A, Betz CS, Siedek V, Kastl KG (2009) CMC packing in functional endoscopic sinus surgery: does it affect patient comfort? Rhinology 47(1):36–40PubMed

Gall RM, Witterick IJ, Shargill NS et al (2002) Control of bleeding in endoscopic sinus surgery: use of a novel gelatin-based hemostatic agent. J Otolaryngol 31:271–274CrossRefPubMed

Chandra RK, Conley DB, Kern RC (2003) The effect of FloSeal on mucosal healing after endoscopic sinus surgery: a comparison with thrombin-soaked gelatin foam. Am J Rhinol 17:51–55PubMed

Catalano PJ, Roffman EJ (2003) Evaluation of middle meatal stenting after minimally invasive sinus techniques (MIST). Otolaryngol Head Neck Surg 128(6):875–881CrossRefPubMed

10.

Shekelle PG, Woolf SH, Eccles M, Grimshaw J (1999) Clinical guidelines: developing guidelines. BMJ 318(7183):593–596CrossRefPubMedPubMedCentral

11.

Wang YP, Wang MC, Chen YC, Leu YS, Lin HC, Lee KS (2011) The effects of Vaseline gauze strip, Merocel, and Nasopore on the formation of synechiae and excessive granulation tissue in the middle meatus and the incidence of major postoperative bleeding after endoscopic sinus surgery. J Chin Med Assoc 74(1):16–21CrossRefPubMed

12.

Szczygielski K, Rapiejko P, Wojdas A, Jurkiewicz D (2010) Use of CMC foam sinus dressing in FESS. Eur Arch Otorhinolaryngol 267(4):537–540CrossRefPubMed

13.

Shoman N, Gheriani H, Flamer D, Javer A (2009) Prospective, double-blind, randomized trial evaluating patient satisfaction, bleeding, and wound healing using biodegradable synthetic polyurethane foam (NasoPore) as a middle meatal spacer in functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg 38(1):112–118PubMed

14.

Berlucchi M, Castelnuovo P, Vincenzi A, Morra B, Pasquini E (2009) Endoscopic outcomes of resorbable nasal packing after functional endoscopic sinus surgery: a multicenter prospective randomized controlled study. Eur Arch Otorhinolaryngol 266(6):839–845CrossRefPubMed

15.

Vaiman M, Eviatar E, Shlamkovich N, Segal S (2005) Use of fibrin glue as a hemostatic in endoscopic sinus surgery. Ann Otol Rhinol Laryngol 114(3):237–241CrossRefPubMed

16.

Baumann A, Caversaccio M (2003) Hemostasis in endoscopic sinus surgery using a specific gelatin-thrombin based agent (FloSeal). Rhinology 41(4):244–249PubMed

17.

Miller RS, Steward DL, Tami TA, Sillars MJ, Seiden AM, Shete M, Paskowski C, Welge J (2003) The clinical effects of hyaluronic acid ester nasal dressing (Merogel) on intranasal wound healing after functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 128:862–869CrossRefPubMed

18.

Wee JH, Lee CH, Rhee CS, Kim GW (2012) Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhinolaryngol 269:897–903CrossRefPubMed

19.

Hu KH, Lin KN, Li WT, Huang HM (2008) Effects of Meropack in the middle meatus after functional endoscopic sinus surgery in children with chronic sinusitis. Int J Pediatr Otorhinolaryngol 72(10):1535–1540CrossRefPubMed

20.

Jameson M, Gross CW, Kountakis SE (2006) FloSeal use in endoscopic sinus surgery: effect on postoperative bleeding and synechiae formation. Am J Otolaryngol 27(2):86–90CrossRefPubMed

21.

Wormald PJ, Boustred RN, Le T et al (2006) A prospective singleblind randomized controlled study of use of hyaluronic acid nasal packs in patients after endoscopic sinus surgery. Am J Rhinol 20:7–10PubMed

22.

Frenkiel S, Desrosiers MY, Nachtigal D (2002) Use of hylan B gel as a wound dressing after endoscopic sinus surgery. J Otolaryngol 31(Suppl 1):S41–S44CrossRefPubMed

23.

Kimmelman CP, Edelstein DR, Cheng HJ (2001) Sepragel sinus (hylan B) as a postsurgical dressing for endoscopic sinus surgery. Otolaryngol Head Neck Surg 125(6):603–608CrossRefPubMed

24.

Tom LW, Palasti S, Potsic WP, Handler SD, Wetmore RF (1997) The effects of gelatin film stents in the middle meatus. Am J Rhinol 11(3):229–232CrossRefPubMed

25.

Bugten V, Nordgard S, Skogvoll E, Steinsvag S (2006) Effects of nonabsorbable packing in middle meatus after sinus surgery. Laryngoscope 116(1):83–88CrossRefPubMed

26.

Shikani AH (1994) A new middle meatal antrostomy stent for functional endoscopic sinus surgery. Laryngoscope 104(5 Pt 1):638–641CrossRefPubMed

27.

Weitzel EK, Wormald PJ (2008) A scientific review of middle meatal packing/stents. Am J Rhinol 22(3):302–307CrossRefPubMed

28.

Muluk NB, Oguztürk O, Ekici A, Koç C (2005) Emotional effects of nasal packing measured by the Hospital Anxiety and Depression Scale in patients following nasal surgery. J Otolaryngol 34(3):172–177CrossRefPubMed

29.

Weber R, Hay U (2003) Ist die Nasentamponade noch zeitgemäß? Laryngorhinootologie 82(9):650–654CrossRefPubMed

30.

Shaw CL, Dymock RB, Cowin A, Wormald PJ (2000) Effect of packing on nasal mucosa of sheep. J Laryngol Otol 114(7):506–509CrossRefPubMed

31.

McIntosh D, Cowin A, Wormald PJ (2005) The effect of an expandable polyvinyl acetate (Merocel) pack on the healing of the nasal mucosa of sheep. Am J Rhinol 19(6):577–581PubMed

32.

McIntosh D, Cowin A, Adams D, Rayner T, Wormald PJ (2002) The effect of a dissolvable hyaluronic acid-based pack on the healing of the nasal mucosa of sheep. Am J Rhinol 16(2):85–90PubMed

33.

Rajapaksa SP, Cowin A, Adams D, Wormald PJ (2005) The effect of a hyaluronic acid-based nasal pack on mucosal healing in a sheep model of sinusitis. Am J Rhinol 19(6):572–576PubMed

34.

Rajapaksa S, McIntosh D, Cowin A, Adams D, Wormald PJ (2005) The effect of insulin-like growth factor 1 incorporated into a hyaluronic acid-based nasal pack on nasal mucosal healing in a healthy sheep model and a sheep model of chronic sinusitis. Am J Rhinol 19(3):251–256PubMed

35.

Robinson S, Adams D, Wormald PJ (2004) The effect of nasal packing and prednisolone on mucosal healing and reciliation in a sheep model. Rhinology 42(2):68–72PubMed

Title: How effective is postoperative packing in FESS patients? A critical analysis of published interventional studies
Authors: Petros V. Vlastarakos
Emily Iacovou
Melina Fetta
Marios Tapis
Thomas P. Nikolopoulos
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 12/2016
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-015-3863-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How effective is postoperative packing in FESS patients? A critical analysis of published interventional studies

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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