A retrospective study of 160 adults with chronic rhinosinusitis and nasal polyps found that those who underwent endoscopic sinus surgery experienced significantly faster recovery and fewer complications compared with those who underwent traditional open sinus surgery.
Patients were treated between January 2020 and December 2022 and randomly assigned to either endoscopic (n = 80) or open sinus surgery (n = 80) after failing to respond to at least 12 weeks of standardized medical therapy.
Compared with the traditional group, the endoscopic group had significantly shorter surgery duration (31.1 ± 4.2 min vs 39.4 ± 5.2 min; P < .05) and less intraoperative blood loss (13.2 ± 3.4 mL vs 34.7 ± 7.9 mL; P < .05). Time to nasal mucosal recovery, restoration of nasal ventilation, and length of hospital stay were also shorter in the endoscopic group (all P < .05).
Postoperative complications occurred in 1 patient (1.3%) in the endoscopic group compared with 8 patients (10.0%) in the open surgery group. Complications included nasal adhesions and hematoma, which were more frequent in the open group.
Pain scores, measured using a visual analog scale (0–10), were significantly lower in the endoscopic group on postoperative days 1 (4.5 ± 1.2 vs 6.3 ± 1.6), 2 (3.8 ± 1.2 vs 5.7 ± 1.4), and 3 (3.3 ± 0.8 vs 5.0 ± 1.4; all P < .05).
Inflammatory markers, including serum C-reactive protein and interleukin-6, declined more rapidly postoperatively in the endoscopic group. By day 3, mean CRP levels were 5.3 ± 1.1 mg/L in the endoscopic group vs 6.8 ± 1.3 mg/L in the open group. Interleukin-6 levels were 18.1 ± 1.6 ng/L vs 21.1 ± 2.2 ng/L, respectively (P < .05).
Measures of immune function, specifically CD3⁺ and CD4⁺/CD8⁺ ratios, showed more favorable postoperative values in the endoscopic group (CD3⁺: 41.9% vs 39.1%; CD4⁺/CD8⁺: 1.41 vs 1.09; P < .05).
Sleep outcomes also favored the endoscopic group. Patients in this group had shorter latency to sleep (33.8 ± 7.9 min vs 42.6 ± 8.7 min), longer total sleep time (7.8 ± 1.0 h vs 6.8 ± 1.0 h), and better sleep quality scores (10.5 ± 1.3 vs 12.4 ± 1.6; P < .05), as assessed using the Pittsburgh Sleep Quality Index.
Quality of life, assessed using the WHOQOL-BREF questionnaire, improved in both groups but significantly more in the endoscopic group across all domains (physical, psychological, social, and environmental). Postoperative physical health scores in the endoscopic group were 89.7 ± 6.2 vs 82.9 ± 6.4 in the open group (P < .05).
The authors concluded that nasal endoscopic surgery may offer a less invasive alternative to open sinus surgery, with improved outcomes in perioperative metrics, postoperative inflammation, immune response, sleep, and quality of life. They noted that additional long-term studies are needed to confirm the durability of these findings.
No competing interests were reported.
Source: BMC Surgery