Microdebrider-Assisted Versus Conventional Endoscopic Sinus Surgery for Sinonasal Polyposis: A Prospective Comparative Study

Abstract

Background: Endoscopic sinus surgery (ESS) is the standard surgical treatment for sinonasal polyposis that fails medical therapy, but the best choice of instrumentation remains debated. This study compared intraoperative and postoperative outcomes of microdebrider-assisted and conventional ESS.
Methods: In this prospective comparative study at a tertiary care teaching hospital, 70 patients aged 20–50 years with sinonasal polyposis underwent either microdebrider-assisted ESS (n = 35) or conventional ESS (n = 35). Operative time, blood loss and surgical field visibility were recorded intraoperatively. Synechiae, crusting, middle meatal collapse, recurrence, Meltzer grade and quality of life were assessed during 6 months of follow-up.
Results: The groups were comparable in age, sex and preoperative Meltzer grade. The microdebrider group had shorter operative time (62.4 ± 8.6 vs 78.7 ± 10.2 min; p < 0.001), less blood loss (82.5 ± 15.4 vs 128.3 ± 22.6 mL; p < 0.001) and more often good field visibility (80% vs 40%; p = 0.002). Synechiae (8.6% vs 31.4%; p = 0.018), crusting (14.3% vs 40.0%; p = 0.014) and middle meatal collapse (5.7% vs 25.7%; p = 0.021) were less frequent. Recurrence at 6 months was 5.7% vs 22.9% (p = 0.042). More patients reached Meltzer grade 0 (74.3% vs 45.7%; p = 0.011), and the mean quality-of-life improvement was greater (50.2 vs 40.4 points; p = 0.003).
Conclusion: Microdebrider-assisted ESS was associated with greater operative efficiency, fewer early postoperative complications, better disease clearance and larger quality-of-life gains than conventional ESS. Randomised multicentre studies with longer follow-up are needed to confirm these findings.