Revision Endoscopic Sinus Surgery
Primary ESS provides effective relief and a good of symptoms in the
majority of the patients (21). However, several studies have highlighted
that a percentage of patients remain uncontrolled in the post-operative
phase despite optimal medical care and good compliance with local
treatment (14, 21, 32, 33). In case of persistent uncontrolled CRSwNP,
physicians need to explore the varying reasons for relapse or
persistence which may be related to such factors as diagnosis,
treatment, patient and surgery performed, before considering the next
step of care for CRSwNP (34). The goals of revision ESS should be
carefully determined and may include the removal of obstructing polyps,
addressing any residual anatomical issues that may contribute to
recurrence such as scar tissue or insufficiently opened sinuses or the
presence of complications such as mucocele formation. In the shared
decision-making process, clinicians and patients must consider
symptomatology, goals of the revision surgery, impact of the surgery on
the patient ( including the potential for an increased risk of
intra-operative complications), post operative compliance to
anti-inflammatory treatment and the chronicity of the disease (18, 35).
Revision ESS can be more challenging than the primary surgery due to
scarring and altered anatomy from previous procedures (36) resulting in
a higher risk of complications (37). The surgeon must carefully assess
the extent of inflammation, the presence of fibrosis and chronic
osteitis and the potential impact on adjacent structures and include the
higher complication risk in the decision process. This in turn may lead
to a longer recovery period and higher indirect costs due to sick leave
(25 , 31, 38).