Functional endoscopic sinus surgery in the paediatric population: Outcome of a conservative approach to postoperative care

Functional endoscopic sinus surgery (FESS) has become a widely used and eff ective tool in treating chronic sinusitis refractory to medical therapy. Re ported success rates, defined mainly on the basis of improvement of preoper ative symptoms, have been encouraging and ranged between 71 and 93%. Howeve r, in most of these studies, a second-look endoscopy under general anaesthe sia was performed 2 to 3 weeks following the initial surgery in order to de bride and clean the operative site. In this study, we present the outcome o f FESS in our centre, where a second-look endoscopy was never performed. A retrospective study on all of the patients operated on between May 1987 and May 1997 was undertaken. All 35 patients had symptoms of sinusitis and had received initial medical therapy for at least 2 months. Only those who did not improve were considered candidates for surgery. Prior to the operation , all patients had computed tomography scan of the sinuses to document the extent of their disease. Eleven patients (31%) had asthma, 3 patients had c ystic fibrosis, 1 had leukemia, 1 had immotile cilia, and 1 had Kartagener' s syndrome. The period of follow-up ranged between 3 months and 5 years. Su ccess was determined by resolution or improvement of the preoperative sympt oms as assessed during their latest follow-up visit. Our data show an overa ll success rate of 74%. More than half of the patients (56%) who had recurr ence of symptoms had an underlying systemic condition (cystic fibrosis, leu kemia, or ciliary dyskinesia); however, these patients showed an initial im provement during the first few months following FESS. Also, five patients ( 14%) required revision FESS within 1 to 3 years following their initial sur gery; four of those patients (80%) had an underlying systemic condition. Ba sed on these results, we conclude that second-look endoscopy is of no benef it following routine FESS since our success rates are comparable to those r eported in the literature.