Safety and Efficacy of the Endoscopic Modified Lothrop Procedure: A Systematic Review and Meta-Analysis

✍ Scribed by Peter C. Anderson; Raj H. Sindwani

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 160 KB
• Volume: 119
• Category: Article
• ISSN: 0023-852X
• DOI: 10.1002/lary.20438

✦ Synopsis

OBJECTIVES:

The endoscopic modifi ed Lothrop procedure (EMLP; also known as Draf III or frontal drillout) has recently gained popularity as a minimally-invasive alternative to frontal sinus obliteration. This systematic analysis was designed to assess the safety and effi cacy of the EMLP.

STUDY DESIGN: Literature review and meta-analysis.

METHODS:

We performed a search of all English studies published from 1990 to 2008 that reported results from a minimum of fi ve patients undergoing the EMLP. Of the 37 papers reviewed, 18 studies (evidence level II-2 or II-3) containing data from 612 patients met inclusion criteria.

RESULTS:

The most common indications for EMLP were chronic frontal sinusitis (75.2%) and mucocele (21.3%). Patients had an average age of 47.9 years (range, 14 to 89 years) and were followed for 28.5 months postoperatively. Only 20.3% of procedures were performed without image-guidance. Stents were rarely used (6%). The rate of major and minor complications was <1% and 4%, respectively. No deaths were reported. Majority of patients were discharged within 24 hours. Postoperative endoscopic fi ndings, qualitatively reported in 394 patients, demonstrated frontal sinus patency or partial stenosis in 95.9% at last follow-up. Where specifically assessed (n=430 patients), improvement in symptoms was achieved in 82.2% of cases, with 16% reporting no signifi cant change, and 1.2% reporting worsening of symptoms. The overall failure rate (requiring further surgery) of EMLP was 13.9% (85/612). Eighty percent of failures underwent revision EMLP, while 20% elected osteoplastic frontal sinus obliteration.

CONCLUSIONS: When performed by an experienced surgeon, EMLP is a safe and effi cacious procedure which is well tolerated.