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Endoscopic modified Lothrop procedure after failure of primary endoscopic sinus surgery: a meta-analysis
Waleed M Abuzeid1, Mayand Vakil1, Juan Lin2
1Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY.
International Forum of Allergy & Rhinology
|December 7, 2017
Summary
The endoscopic modified Lothrop procedure (EMLP) offers effective salvage for frontal sinusitis after initial surgery. This study found EMLP improved symptoms in over 80% of patients, demonstrating its efficacy in complex cases.
Area of Science:
- Otolaryngology
- Neurosurgery
- Rhinology
Background:
- Frontal sinusitis often requires revision surgery after initial endoscopic sinus surgery (ESS) failure.
- The endoscopic modified Lothrop procedure (EMLP) serves as a salvage technique for these refractory cases.
Purpose of the Study:
- To evaluate the safety and efficacy of the EMLP as a salvage procedure for frontal sinusitis.
- To analyze outcomes following EMLP after primary ESS failure.
Main Methods:
- Systematic review and meta-analysis of English-language publications from 2000-2016.
- Included studies reported EMLP use after primary ESS, adhering to PRISMA guidelines.
- Extracted and summarized patient demographics, comorbidities, and surgical outcomes.
Main Results:
- Eleven studies with 778 patients (86.5% with chronic rhinosinusitis) were analyzed.
- EMLP achieved symptom improvement in 82.3% of patients with a mean follow-up of 28.4 months.
- Complications included CSF leak (2.5%), neo-ostium restenosis (17.1%), and reoperation (9.0%). Aspirin sensitivity impacted CSF leak and closure rates.
Conclusions:
- The EMLP is a viable and effective salvage option for patients with refractory frontal sinusitis.
- Evidence from higher-volume centers supports EMLP's role in managing complex sinonasal disease.
