Recurrences of surgery for antrochoanal polyps in children: A systematic review

Publication date: Available online 3 January 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Francesca Galluzzi, Lorenzo Pignataro, Marcello Maddalone, Werner Garavello
ObjectivesThe main purpose was to evaluate the recurrence rate after surgery for antrochoanal polyps (ACPs) in children; secondly, we have analyzed the rate of recurrence for different types of surgery and the risk factors involved.MethodsWe performed a systematic review searching PubMed and MEDLINE databases including English-language published studies from June 1989 to October 2017 regarding surgical treatment of ACPs in children.ResultsWe included thirteen studies, eight were retrospective and five prospective, with 285 participants, the mean rate of recurrence after ACPs surgery was 15.0% (95% CI:11.0–20.0). Functional endoscopic sinus surgery (FESS) was the main type of surgery used for primary cases (75.4%) followed by the combined approach i.e. FESS with a transcanine sinusoscopy or mini Caldwell-Luc (14%), the Caldwell-Luc (CWL) (8%) and simple polypectomy (SP) (2.8%). Our analysis has demonstrated a significant reduction of recurrences using the combined approach 0% (95% CI: 0.0–8.0) compared with FESS 17.7% (95% CI: 12.8–23.4) or SP 50% (95% CI:15.7–84.3) (p < .05) but no significant differences with CWL 9.1% (95% CI: 1.1–29.2) and others surgical approaches (p > .05). The analysis of the possible risk factors involved in recurrences are inconclusive.ConclusionRecurrences of ACPs in children are still high. The endoscopic sinus surgery is considered the first choice for primary treatment, whilst the external approach may be a valid option in case of recurrence. It seems that the combined approach could reduce recurrence rates in selected patients that cannot be completely managed with endoscopy.



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