Middle Meatal Spacers for Synechiae Prevention Following Endoscopic Sinus Surgery: An Updated Systematic Review and...

Area of Science:

• Otolaryngology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Postoperative synechiae (adhesions) are a common complication following endoscopic sinus surgery (ESS).
• Middle meatal spacers are used to prevent these adhesions, but evidence comparing different materials is evolving.

Purpose of the Study:

• To evaluate the efficacy of middle meatal spacers in reducing postoperative synechiae after ESS.
• To compare the effectiveness of absorbable versus nonabsorbable spacer materials in preventing synechiae.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
• Searched major databases (PubMed/MEDLINE, Embase, Web of Science) for randomized controlled trials (RCTs) from January 2012 to March 2025.
• Included 9 RCTs (703 patients) comparing middle meatal spacers to no-spacer controls, with synechiae within 3 months as the primary outcome.

Main Results:

• Middle meatal spacers significantly reduced postoperative synechiae (RR 0.43; 95% CI 0.26-0.71).
• Absorbable spacers showed a statistically significant protective effect (RR 0.48; 95% CI 0.25-0.93).
• Nonabsorbable spacers showed a nonsignificant protective trend; no significant difference was found between absorbable and nonabsorbable types. Steroid-eluting spacers did not show clear superiority.

Conclusions:

• Middle meatal spacers effectively reduce postoperative synechiae following ESS.
• Absorbable materials provide the most consistent evidence for synechiae prevention.
• Selective, rather than routine, use of spacers is recommended due to variable baseline risks.