Systematic review and meta-analysis of the curative effects and safety of endoscopic sinus surgery in children with chronic sinusitis with nasal polyps

Abstract

Background: At present, the surgical treatment of sinusitis with nasal polyps has made great progress, but its recurrence rate is still high. Therefore, this time, meta-analysis is used to study the therapeutic effect of endoscopic sinus surgery on children with chronic sinusitis with nasal polyps, analyze its effectiveness and safety, and provide theoretical basis for clinical treatment.Methods: Boolean logic searching was adopted to retrieve articles from various databases, including PubMed, Medline, and Chinese National Knowledge Infrastructure (CNKI), published from the establishment of the database to December 30, 2021. The following search terms were used: "endoscopic sinus surgery", "antrochoanal polyps", "chronic sinusitis with nasal polyps", and "nasal polyps". Comparative studies on traditional surgical treatment and endoscopic sinus surgery were also screened out. Review Manager was utilized for meta-analysis.Results: A total of 9 references were included in the study, and most of them were low risk bias (medium and high quality). Meta-analysis showed that there was no statistical heterogeneity between the control group and the experimental group (Chi 2 =0.03, I 2 =0%, P=0.98). According to the fixed effect model analysis, the number of patients with polyp formation in the experimental group was significantly less than that in the control group (Z=2.65, P=0.008). Compared with the control group, there is no statistical heterogeneity in the postoperative recurrence (Chi 2 =1.59, I 2 =0%, P=0.45). According to the analysis of fixed effect model, the postoperative recurrence in the experimental group is significantly less than that in the control group (Z=2.92, OR =2.78, 95% CI: 1.40-5.52, P=0.004). Compared with the control group, the results of postoperative visual analogue scale (VAS) were statistically different (Chi 2 =12.63, I 2 =84%, P=0.002). According to the random effect model analysis, the VAS score of the experimental group was significantly lower than that of the control group (Z=18.06, MD =4.51, 95% CI: 3.96-5.05, P<0.00001).Discussion: Endoscopic sinus surgery could reduce the postoperative recurrence and pain of patients, and showed high curative effects and safety in the treatment of children with chronic sinusitis with nasal polyps.

Improvement and clinical benefit analysis of low-dose ketamine on postoperative pain and sleep after sinus surgery

“…(1) patients with complete medical records; (2) those without severe cardiovascular, respiratory, hepatic or renal diseases; (3) those with a preoperative American Society of Anesthesiologists (ASA) classi cation of I to III; (4) those who were 18-70 years old; (5) those without hormones and immunosuppressant used before surgery; (6) those whose operation time was 8-17 o'clock; (7) those without a history of pepticulcer disease; (8) those without a history of addiction to analgesic drugs; (9) those without a history of migraine disease; (10) those who could cooperate with physical examination and pain assessment. The exclusion criteria were as follows: (1) those with an operative time of < 60 min or > 180 min; (2) those with an operative bleeding volume of 20-200 ml; (3) those with intraoperative and postoperative allergic reactions; (4) those without cooperating with postoperative treatment and follow-up visits; (5) those with the developed severe infections after surgery; and (6) psychiatric patients.…”

“…Functional endoscopic sinus surgery (FESS) thoroughly removes diseased tissues and restores normal morphology and physiological function of nasal and sinus mucosa [4] . FESS, characterized by small trauma, a clear operative eld, and a broad surgical perspective, has been regarded as a preferred surgical technique for the treatment of CRS [5] . Although FESS causes tremendous pain in breathing, swallowing, and other postoperative maneuvers due to the anatomical structure of the surgical site and the peculiarities of physiological functions, such as postoperative head and face pain, especially in those with nasal packing and mainly manifests as nasal distension, and most in the whole head which seriously affects their sleep and diet [6] .…”

The application of enhanced recovery after surgery (ERAS) in chronic rhinosinusitis patients undergoing endoscopic sinus surgery: A systematic review and meta-analysis

“…ERAS elements adopted by these studies ranged from 6 to 14. In terms of the research contents, ten studies [16,[21][22][23][24][25][26][27][28][29] had reported LOS, 13 studies [5,16,21,23,24,26,[28][29][30][31][32][33][34] had outcomes on the incidence of overall postoperative complication, nine studies [5,16,23,29,30,32,[35][36][37] reported PONV, eight studies [24,26,30,32,33,[35][36][37] on facial edema, seven studies [24,26,32,33,[35][36][37] on low back pain and urinary retention, five studies [21,23,…”

“…Thirteen studies (a total of 1274 patients) [5,16,21,23,24,26,[28][29][30][31][32][33][34] reported overall postoperative complications. Specifically, 9 studies [5,16,23,29,30,32,[35][36][37] reported PONV (involving 926 CRS patients), 8 studies [24,26,30,32,33,[35][36][37] for facial edema (involving PLOS ONE…”

“…Seven RCTs [30,31,34,42,43,45,46] and five RCTs [30,31,34,42,43], involving 594 and 428 patients, reported anxiety score and depression score, respectively. Among the anxiety results, 5 studies [31, 34,42,45,46], 1 study [43] and 1 study [30] reported using SAS scale, HAMA scale and GAD-7 scale to evaluate the anxiety score respectively.…”