Effects of Meropack in the middle meatus after functional endoscopic sinus surgery in children with chronic sinusitis

Objectives: The aim of the study was to evaluate the effects and morbidities of Meropack, an absorbable hyaluronic acid packing material, placed in the middle meatus after endoscopic sinus surgery in children with chronic sinusitis. Methods: Sixty consecutive children with similar degrees of bilateral chronic sinusitis were enrolled in the study. Meropack was randomly inserted into one side of the middle meatus, while the opposite sinus was not packed after functional endoscopic sinus surgery. Patients were investigated 3, 8, and 12 weeks after surgery. The effects and morbidities of nasal dressings in the middle meatus were evaluated with respect to six distinct parameters: blood toss during surgery, postoperative hemorrhage, synechiae, granulation tissue, infection, and patency of the maxillary sinus ostia. Results: Mean blood loss of packed and unpacked sinuses did not significantly differ (p > 0.05). Twenty-nine (15 packed, 14 unpacked) of the 120 sinuses underwent resection of the lateral wait of concha bullosa. Four of 14 unpacked sinuses had postoperative hemorrhaging, while the 15 packed sinuses did not (p < 0.05). The mean synechiae scores at the first follow-up visit for the Meropack fitted and unpacked sinuses differed significantly (p < 0.05). For the 8- and 12-week follow-up visits, severity of adhesions, granulation tissue formation, infection rate, and patency of the maxillary sinus ostia did not differ significantly between the Meropack fitted sinuses and the unpacked sinuses (p > 0.05 for all). Conclusion: Meropack dressings effectively prevented postoperative hemorrhage, but did not significantly reduced synechiae after endoscopic sinus surgery. Therefore, we recommend that Meropack packing is not necessary for routine use following pediatric functional endoscopic sinus surgery (FESS). However, it should be reserved for children who are predisposed to develop postoperative hemorrhages or adhesions, such as resection of the concha bullosa, traumatic surgery with the creation of large raw surfaces on the middle turbinate, and revision surgery with preexisting adhesions. Crown Copyright (C) 2008 Published by Elsevier Ireland Ltd. All rights reserved.