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

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

doi:10.1007/s00405-015-3863-7

Cited by 13 publications

(15 citation statements)

References 32 publications

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“…Less adhesions and other complications were observed with absorbable and nonabsorbable packing. 13 Also contradictory to our findings, a similar study showed an increased risk of postoperative bleeding in nostrils without packing. 32 Likewise, no significant difference in nasal congestion, pain, or postoperative bleeding was reported with nonabsorbable packing compared to absent packing.…”

Section: Discussioncontrasting

confidence: 99%

“… 30 Also, the same study showed no difference in mucosal adhesions between packed and non‐packed nostrils. Moreover, results from meta‐analyses have concluded that nasal packing did not reduce bleeding post‐surgery, 13 and no significant differences in synechiae formation could be observed between no packing and various packing materials. 31 In addition, packing was not advantageous in terms of postoperative adhesion, and no‐packing methods were suggested to be a cost‐efficient alternative.…”

Section: Discussionmentioning

confidence: 99%

“…12 A meta-analysis reported that absorbable packing was favorable in terms of comfortability and reduced synechiae formation when compared to nonabsorbable and no packing methods, and postoperative bleeding was lower than nonabsorbable packing usage. 13 However, the benefits of absorbable packings are currently under debate. Hence, several studies are unable to provide conclusive evidence regarding postoperative outcome differences between absorbable, nonabsorbable, and no-packing methods.…”

Section: Introductionmentioning

confidence: 99%

“… 12 A meta‐analysis reported that absorbable packing was favorable in terms of comfortability and reduced synechiae formation when compared to nonabsorbable and no packing methods, and postoperative bleeding was lower than nonabsorbable packing usage. 13 …”

Section: Introductionmentioning

confidence: 99%

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Hot saline irrigation in comparison to nasal packing after sinus surgery

Nordström

Jangard

Svedberg

et al. 2021

Laryngoscope Investig Oto

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Objectives: Previous studies have shown that hot saline solution (HSS) nasal irrigation is effective against nasal bleeding and is used to treat nasal hemorrhage. In a pilot study, we evaluated hot saline nasal irrigation in comparison to a routinely used nasal packing in terms of self-reported complications and mucosal healing after functional endoscopic sinus surgery.Methods: Patients undergoing surgery for bilateral chronic rhinosinusitis received polyvinyl acetate (PVA) nasal packing in the left nostril, and the right nostril was rinsed with 47 C sterile saline immediately after surgery. Patients' experiences of pain, bleeding, and other types of uncomfortable experiences were measured using a visual analog scale for each nostril before, during, and immediately after nasal packing removal. Two weeks post-surgery, the assessments were repeated including an endoscopic evaluation of the mucosa by the surgeon.Results: Twenty-seven patients completed the study. Prior to removal of the packing, the patients experienced significantly more pain and other uncomfortable experiences in the nostril treated with nasal packing, as compared to the nostril solely rinsed with hot saline. After removal, patients reported significantly more uncomfortable experiences from the packing treated nostril. Two weeks post-surgery, no difference in mucosal healing was observed between the two nostrils. Conclusions:The results from this study indicate that irrigation with HSS could be an alternative postoperative treatment to conventional PVA nasal packing. Hot saline irrigation may contribute to patients experiencing improved control of postoperative bleeding, pain, and less suffering of other causes as well as health-economic benefits, without affecting the mucosal healing up to 2 weeks post-surgery.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hot saline irrigation in comparison to nasal packing after sinus surgery

Nordström

Jangard

Svedberg

et al. 2021

Laryngoscope Investig Oto

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“…Recent increases in the use of absorbable packing also enables patients to be discharged with nasal packing still in situ if post-operative minor haemorrhage is a concern. 20,21 There remains substantial variation between NHS hospital trusts in England in rates of day-case ESS. In the last full financial year prior to the COVID-19 pandemic a number of trusts still had overnight stay for the majority of patients.…”

Section: Discussionmentioning

confidence: 99%

Safety of day-case endoscopic sinus surgery in England: An observational study using an administrative dataset

Navaratnam

Pendolino

Andrews

et al. 2022

Preprint

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Background: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for many ENT operations including endoscopic sinus surgery (ESS). We aimed to investigate the safety of ESS in England. Methods: This was an observational, secondary analysis of administrative data. Participants were all patients in England undergoing elective ESS procedure aged ≥ 17 years during for the five years from 1st April 2014 to 31st March 2019. The exposure variable was day-case or overnight stay. The primary outcome was emergency readmission within 30 days post-discharge. Results: Data were available for 49,223 patients operated on across 129 NHS hospital trusts. In trusts operating on more than 50 patients in the study period, rates of day-case surgery varied from 100% to 20.6%. Rates of day-case surgery increased from 64.0% in 2014/15 to 78.7% in 2018/19. Day-case patients had lower rates of 30-day emergency readmission (odds ratio 0.71, 95% confidence interval 0.62 to 0.81). For secondary outcomes measures, there was no evidence of poorer outcomes for day-case patients. Outcomes for patients operated on in trusts with ≥80% day-case rates compared to patients operated on in trusts with <50% rates of day-case surgery were similar. Conclusions: ESS can safely be performed as day-case surgery at current rates. There is a potential to increase rates of day-case ESS in England, especially in departments that currently have low rates of day-case ESS.

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Tranexamic acid does not significantly lower postoperative bleeding after endoscopic sinus and nasal surgery

Khanwalkar

Chan

Roozdar

et al. 2023

Int Forum Allergy Rhinol

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BackgroundPostoperative epistaxis is a known possibility following endoscopic sinonasal surgery. Tranexamic acid (TXA) has been shown to reduce intraoperative blood loss and improve the visual field. This study evaluated the clinical efficacy of TXA when given at end of surgery to reduce postoperative bleeding.MethodsThis randomized, double‐blinded placebo‐controlled trial was conducted from April to November 2021. Patients scheduled to undergo endoscopic sinus or nasal surgery were randomized to receive an intravenous dose of 1 g TXA or saline intraoperatively prior to extubation. A 10‐in. visual analog scale (VAS) was used to query patients regarding postoperative bleeding each day for 1 week. The medical record was examined to determine the need for additional evaluations or interventions for epistaxis.ResultsForty patients completed the study. The mean ± SD postoperative bleeding VAS for the TXA group on the day of surgery was not significantly different from the saline group (4.82 ± 2.18 in. vs. 5.03 ± 2.14 in., p = 0.8). There were no significant differences between treatment arms on any postoperative day through day 7 (0.67 ± 1.84 in. vs. 0.87 ± 0.99 in., p = 0.7), nor in the reduction in VAS compared to the respective baseline on the day of surgery. There were no significant differences in terms of additional interventions (e.g., additional evaluation in recovery, ED, or clinic, need for packing, or return to the operating room [OR]).ConclusionAlthough TXA has previously demonstrated efficacy to reduce intraoperative bleeding during sinonasal surgery, when postoperative bleeding is already minimal at baseline, TXA does not appear to reduce it significantly further.

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

Cited by 13 publications

References 32 publications

Hot saline irrigation in comparison to nasal packing after sinus surgery

Hot saline irrigation in comparison to nasal packing after sinus surgery

Safety of day-case endoscopic sinus surgery in England: An observational study using an administrative dataset

Tranexamic acid does not significantly lower postoperative bleeding after endoscopic sinus and nasal surgery

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