A randomized controlled trial on triamcinolone versus saline impregnated merocel post endoscopic sinus surgery:Our experience in a tertiary care centre

Purpose:To assess the potential benefit of impregnating Merocel(a non-absorbable nasal dressing)with a topical steroid solution,for use as a direct and slow local delivery system of steroids after sinus surgery to improve postoperative wound healing.Methods:In this randomized controlled trial,40 patients with bilateral chronic rhinosinusitis with nasal polyposis were subjected to functional endoscopic sinus surgery.Following the completion of the surgery,Merocel packs were inserted in the bilateral nasal cavities and infiltrated with 4 mL triamcinolone(40 mg/mL)in one nasal cavity(treatment group)and 4 mL normal saline in the other(control group).Nasal packs were removed on the third postoperative day and postoperative healing assessment was done on postoperative Weeks 1,2,4,and 12.The findings were noted as per Lund Kennedy(LKES)and perioperative sinus endoscopy(POSE)scores and compared on both sides.Results:Significant(P<0.05)improvement was noted in Lund Kennedy score for crusting and polyp at Week 12,for edema at Week 1,and nasal discharge at Weeks 1 and 12,but there was no significant improvement in scarring at any week.Overall,the difference between the treatment and control arms was statistically significant at all postoperative visits except at Week 4.Also,there was a significant improvement in POSE scores at Weeks 1,2,and 12 but not at Week 4.Conclusion:This study positively concludes that the nasal cavity packed with drug-soaked packs had less scarring and edema in the postoperative period and the overall wound healing was much better as compared to saline-soaked packs.

Percutaneous direct endoscopic pancreatic necrosectomy

Approximately 10%-20% of the cases of acute pancreatitis have acute necrotizing pancreatitis. The infection of pancreatic necrosis is typically associated with a prolonged course and poor prognosis. The multidisciplinary, minimally invasive “step-up” approach is the cornerstone of the management of infected pancreatic necrosis(IPN). Endosonography-guided transmural drainage and debridement is the preferred and minimally invasive technique for those with IPN. However, it is technically not feasible in patients with early pancreatic/peripancreatic fluid collections(PFC)(< 2-4 wk) where the wall has not formed;in PFC in paracolic gutters/pelvis;or in walled off pancreatic necrosis(WOPN) distant from the stomach/duodenum. Percutaneous drainage of these infected PFC or WOPN provides rapid infection control and patient stabilization. In a subset of patients where sepsis persists and necrosectomy is needed, the sinus drain tract between WOPN and skin-established after percutaneous drainage or surgical necrosectomy drain, can be used for percutaneous direct endoscopic necrosectomy(PDEN). There have been technical advances in PDEN over the last two decades.An esophageal fully covered self-expandable metal stent, like the lumen-apposing metal stent used in transmural direct endoscopic necrosectomy, keeps the drainage tract patent and allows easy and multiple passes of the flexible endoscope while performing PDEN. There are several advantages to the PDEN procedure. In expert hands, PDEN appears to be an effective, safe, and minimally invasive adjunct to the management of IPN and may particularly be considered when a conventional drain is in situ by virtue of previous percutaneous or surgical intervention. In this current review, we summarize the indications, techniques, advantages, and disadvantages of PDEN. In addition, we describe two cases of PDEN in distinct clinical situations, followed by a review of the most recent literature.

Evaluation of sheep sinonasal endoscopic anatomy as a model for rhinologic research

Objectives:Despite many publications describing sheep models for functional endoscopic sinus surgery(FESS)procedures,accurate endoscopic anatomical studies are lacking.There are no publications correlating computed tomography(CT)and 3D models with endoscopic anatomical descriptions.This study evaluates and describes the endoscopic anatomy of a sheep model.Methods:Ten live sheep(20-sides)were included.Two cadaveric specimens,imaged using thin slice CT for 3D reconstruction correlation were also included.Using endoscopy,anatomical structures were measured and described.Measurement of the same structures was carried out using the 3D imaging model.Results:Three sets of turbinates were identified at 2.3,5.1 and 8.5 cm from the anterior nasal sill.Frontal recess and uncinate process were identified at 12.7 cm.The septum has a bony and cartilaginous component and measures 10.5 cm.The sphenopalatine foramen was measured at 12.1 cm.All anatomical measurements were correlated with the measurements on the CT scan 3D volume-rendering model,thereby allowing for an accurate description of the sheep sinonasal anatomy.Conclusion:This study describes the endoscopic sinonasal anatomical measurements of the adult sheep.It is the first study to evaluate the sheep CT and endoscopic anatomy in order to determine its feasibility as an animal model for research in FESS.