Patterns and Management of Complications in Elective Septoplasty: A Prospective Longitudinal Study

ObjectiveTo prospectively document the incidence, characteristics, and management of intraoperative and postoperative complications in elective septoplasty performed by supervised residents at a university teaching hospital.MethodsThis prospective longitudinal study enrolled 173 consecutive American Society of Anesthesiologists (ASA) class I patients (age 18-60 years) undergoing elective septoplasty at Al-Mouwasat University Hospital, Damascus. Procedures were performed by residents (PGY 3-4) under continuous attending supervision using the closed Killian technique. Postoperative care included intranasal packing removed on day 2 and Silastic splints removed on day 7, with monthly clinical follow-up for 3 months.ResultsThe cohort was predominantly male (111/173, 64.2%) with a mean age of 26.01 ± 7.65 years. Mean operative duration was 69.84 ± 23.46 minutes and mean intraoperative blood loss 151.45 ± 97.72 mL. Mucosal lacerations occurred in 139 patients (80.3%), of whom 84.9% required no intervention and 15.1% underwent suturing. Intraoperative bleeding resolved within 10 minutes in all but two cases (1.2%), which required electrocoagulation. Laceration size strongly correlated with blood loss (r = 0.634, p < 0.01). Over three months, no patient developed septal perforation, adhesions, postoperative hemorrhage requiring intervention, abscess, or cerebrospinal fluid leak. Minor events included nasal vestibulitis in two patients (1.16%) and postoperative vomiting in nine (5.2%).ConclusionDespite an 80.3% mucosal laceration rate, no major postoperative complication occurred. Prompt intraoperative recognition and selective repair of mucosal tears, rather than their avoidance, appears sufficient to prevent long-term sequelae, even in a supervised resident training setting.