Abuzeid WM, et al. - The safety and efficacy of the endoscopic modified Lothrop procedure (EMLP) were comprehensively evaluated by the researchers, following the failure of primary endoscopic sinus surgery (ESS). The inference drawn was that EMLP was an effective salvage procedure for refractory frontal sinusitis based on data from higher-volume centers.

Methods

• An inquiry was carried out of all English-language publications from 2000 to 2016 reporting the use of EMLP after primary ESS, via the PubMed database and evaluated per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Data was cumulated through meta-analysis with regard to the random effects summaries of patient demographics, comorbidities, and surgical outcomes.

Results

• This research comprised of 11 studies constituting 778 patients.
• It was reported that 86.5% patients had chronic rhinosinusitis (CRS).
• Mean follow-up duration was found to be 28.4 months.
• The mean number of surgeries before EMLP was discovered to be 3.5.
• Symptom improvement was noted among 82.3% of the subjects.
• A mean follow-up of 31.5 months was disclosed via a subgroup analysis of 7 studies in which all 357 patients had CRS.
• The occurrence of symptom improvement was noted in 75.9% of cases and 23.1% experienced polyp recurrence.
• The findings revealed that the cerebrospinal fluid leak rate was 2.5%.
• Restenosis of the neo-ostium occurred in 17.1% with the occurrence of complete closure in 3.9% of cases.
• The reoperation rate after EMLP was displayed to be 9.0%.
• A link was determined between aspirin sensitivity with an increased risk of cerebrospinal fluid (CSF) leak (p=0.0339) and a reduced incidence of neo-ostium closure (p=0.0001).
• Aspirin sensitivity and asthma illustrated a connection with a reduced incidence of reoperation (p ≤ 0.001) and increased symptom improvement (p < 0.005).
• The findings demonstrated the correlation between restenosis or closure of the frontal neo-ostium with less symptom improvement (p < 0.04) but not with reoperation.