Randomised controlled trial to evaluate efficacy of intraoperative use of silastic in endoscopic sinus surgery

Abstract Introduction Postoperative nasal synechiae is one of the common complications following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS), which often leads to suboptimal results and a higher likelihood of requiring revision procedures. Although various intra- and postoperative interventions, including Silastic stents, have been utilised to reduce these complications, the effectiveness of intraoperative Silastic sheet placement remains unexplained in the literature. Objective This randomised controlled trial aimed to evaluate whether intraoperative placement of Silastic sheets during ESS could reduce postoperative synechiae and improve patient outcomes compared to conventional postoperative Silastic placement. Methods A prospective, randomized controlled study was conducted on 38 adult patients with CRS undergoing ESS at a tertiary care centre. They were randomly allocated to two equal groups: Group A underwent intraoperative Silastic sheet placement, removed at the end of surgery, while group B received Silastic sheets at the end of surgery, retained for 2 weeks. The incidence of postoperative synechiae was assessed using nasal endoscopy at 2 and 4 weeks. Patient pain and nasal function were evaluated via the Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) score, respectively. Results At the 2-week follow-up, one patient (5.3%) in Group A developed nasal synechiae, compared to none in Group B; this difference was not statistically significant. VAS scores were significantly lower in group A at 2 weeks ( p = 0.001), suggesting better early comfort. By 4 weeks, no synechiae were observed in either group, and VAS and NOSE scores were comparable. Conclusion Intraoperative Silastic sheet placement during ESS is as effective as short-term postoperative placement in preventing early synechiae formation. While prolonged Silastic retention may further lower adhesion risk, immediate intraoperative removal is associated with improved early postoperative comfort without compromising long-term outcomes. This study supports individualised timing of Silastic implantation to optimise both healing and patient comfort after ESS.