Comparison of the surgical outcome between primary and revision endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis

Background and objectives: Many studies have examined the prognostic factors affecting the success of endoscopic sinus surgery (ESS), and a history of previous ESS is generally regarded as a factor contributing to a poor surgical outcome. The aim of this study was to investigate whether previous ESS with polypectomy is really associated with poor surgical outcomes after revision ESS (RESS) by comparing the postoperative results between primary ESS (PESS) and RESS groups for chronic rhinosinusitis with nasal polyposis. Materials and methods: A retrospective analysis of prospectively collected data was performed on 2 groups with a minimum 1-year follow-up: patients who underwent PESS with polypectomy (101 patients) and those who required RESS with polypectomy (24 patients). The extent of disease was compared using the Lund-MacKay scoring system, and the degree of polyposis was measured. Subjective patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) questionnaire, and objective endoscopic physical findings were scored according to the parameters preoperatively and 6 and 12 months postoperatively. The surgical outcomes of the PESS and RESS groups were compared using the SNOT-20 and nasal endoscopy scores. Results: The Lund-Mackay score and degree of preoperative polyposis did not differ statistically between the groups. The preoperative mean SNOT-20 and nasal endoscopy scores were improved significantly at 6 and 12 months postoperatively, and the subjective and objective surgical outcomes of the 2 groups did not differ statistically. The need for additional medications during the follow-up period and the proportion of patients who required additional surgical intervention due to surgical failure was similar in both groups. Conclusion: The results of this study suggest that a history of ESS with polypectomy does not predict an unsuccessful surgical outcome after RESS and that ESS with polypectomy is a reliable and effective method for improving a patient's quality of life regardless of primary or revision surgery. (C) 2008 Elsevier Inc. All rights reserved.