Middle meatal spacers for the prevention of synechiae following endoscopic sinus surgery: a systematic review and meta-analysis of randomized controlled trials

Background: Middle meatal (MM) synechiae is the most common complication following endoscopic sinus surgery (ESS) for chronic rhinosinusitis. To prevent synechiae formation, a variety of MM spacers have been employed, with varying success in the reported literature. There remains a continued debate on whether MM spacers actually reduce the risk of synechiae following ESS. Methods: The Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was used for reporting this review of randomized controlled trials evaluating the effectiveness of MM spacers compared to no spacers in patients undergoing ESS. Where appropriate, a meta-analysis on outcome data using a random effects model was performed. Results: Eight randomized controlled trials were included in this systematic review. A pooled analysis on relevant trials found a nonsignificant trend favoring MM spacers compared to no spacers for the prevention of synechiae following ESS (relative risk [RR], 0.40; 95% confidence interval [CI], 0.14-1.12). Subgroup analysis suggested that nonabsorbable spacers (NAS) may be more effective than absorbable spacers (AS) for reducing the risk of synechiae compared to no spacers. Conclusion: MM spacers may be more effective than no spacers for the prevention of synechiae following ESS, especially when employing the use of an NAS. However, significant heterogeneity is observed among included trials and future studies are needed to further validate these findings. (c) 2012; 2:477486