FESS Surgery - Procedure Steps, Complications, Recovery

Functional endoscopic sinus surgery, FESS full form, is a minimally invasive procedure that treats chronic sinus infections. It also manages sinus-related disorders, such as nasal polyps and deviated septum. 

During surgery, an endoscope (a thin, flexible tube with a light and a camera on the end) is inserted into the nasal passages. This avoids the need for incisions in or around the nose. 

The “functional” aspect in its name refers to the following goals of the procedure: 

1. Decrease the frequency and intensity of sinus infections 

2. Alleviate symptoms of sinusitis 

3. Enhance the drainage of the sinuses 

4. Improve airflow through the nasal passages 

5. Improve the sense of smell 

Anatomy and Physiology of Sinuses

The sinuses are hollow cavities in the skull that produce mucous to moisturise the nose and protect it from pollutants, dust, and dirt. It also helps to regulate the temperature and humidity of the air reaching the lungs.

The four pairs of sinuses are as follows: 

1. Maxillary Sinuses: The largest sinus, located on both sides of the nose, near the cheekbones

2. Frontal Sinuses: Found above the eyes, in the forehead bone

3. Ethmoid Sinuses: Located near the eyes on each side of the nasal bridge

4. Sphenoid Sinuses: Situated deep in the skull behind the eyes

FESS surgery is recommended for patients with sinus conditions that do not improve with medical treatments. It is needed for individuals who experience symptoms like pain, nasal congestion, breathing difficulty, and loss of smell due to the following conditions: 

1. Sinusitis (a chronic or persistent inflammation of the sinuses)

2. Nasal polyps (non-cancerous growths in the lining of the sinuses or nasal passage)

3. Nasal blockage or obstruction (can be caused by a deviated septum, sinusitis, nasal polyps, allergies, etc.)

4. Nasal and sinus tumours (cancerous growths that occur in the nose or sinuses)

FESS surgery is a minimally invasive procedure with various benefits, making it a preferred method for treating chronic sinusitis. Between 80% and 90% of individuals who undergo this surgery report that it effectively resolved their condition. The advantages include: 

1. Reduced risk of scarring 

2. Less tissue damage 

3. Precise visualisation and surgical accuracy 

4. Shorter recovery time (most individuals can return to routine activities within two weeks)

Patients meet an ENT surgeon to prepare for their sinus procedure. The specialist gives them specific instructions to be followed before and on the day of surgery. These include: 

Before FESS Surgery 

For patients who smoke, preparation begins 3-4 weeks before FESS surgery, as they will be told to quit smoking. Other arrangements that need to be made before the procedure are as follows: 

On the Day of FESS Surgery 

Patients should arrive at the hospital or surgical facility well before their scheduled time on the day of the FESS procedure. This helps them handle any last-minute administrative tasks. They will be prepped for surgery, which includes the following: 

The FESS surgery is performed under general anaesthesia, so the patient is asleep. It takes about two hours to complete and involves the following steps: 

1. Nasal Endoscopy: The surgeon inserts an endoscope into the nostrils. It helps visualise the sinus passages.

2. Surgical Intervention: Using specialised instruments alongside the endoscope, the surgeon carefully removes obstructive tissue, polyps, and other blockages within the sinus pathways. 

3. Restoration of Drainage: The main objective is to restore natural drainage and function of the sinuses. This is done by clearing the blocked passages and correcting anatomical issues, such as a deviated septum. 

4. Closure: Since FESS is minimally invasive, there are no external incisions and do not require sutures. The endoscope and instruments are removed once the procedure is completed.

It is expected to experience some bleeding, pain, and fatigue for up to a week after the operation. However, it can often be managed with the instructions provided by the doctor. The guidelines for a smooth sinus surgery recovery are as follows: 

Recovery in the Hospital

Most patients can return home on the same day of the procedure. An overnight hospital stay is required in cases where individuals experience bleeding during the surgery. They can expect the following in the hospital: 

1. After FESS surgery, patients will be closely monitored in the recovery room until they wake up from anaesthesia.  

2. Medical staff will check their vital signs, such as blood pressure and heart rate, and monitor their condition for immediate complications.

3. The healthcare team will provide pain medication to help manage any discomfort. 

4. If a nasal packing (sterile material in the nasal passages to control bleeding) is placed, it will be removed the following day. 

5. The individual will need someone to drive them home. 

At-Home Recovery

Most patients can expect to feel normal after sinus surgery in a month or two. They can return to school and work within a week and resume their regular activities in two weeks. During this time, they should follow these guidelines: 

1. Take prescribed pain medications. Do not take aspirin or non-steroidal anti-inflammatory (NSAID) medications for two weeks after surgery. 

2. The doctor may recommend saline nasal irrigation twice daily to help keep the nasal passages clean and moist.

3. Use nasal saline mist sprays every two to three hours after FESS. 

4. Avoid blowing the nose for seven days. If a patient needs to sneeze, they should keep their mouth open or sneeze in their sleeve. 

5. Refrain from strenuous activities and heavy lifting for ten days post-surgery. 

First Follow-Up Appointment

The first follow-up visit is scheduled between four and eight weeks after the surgery. During the visit, the doctor cleans the fluid and blood from the nose and sinuses. They also check on the patient’s progress and monitor for any complications. 

Functional endoscopic sinus surgery is widely regarded as a safe and effective treatment. According to a study by Suzuki et al., the complication rate after the procedure is 0.5%. These risks may include: 

1. Excessive bleeding 

2. Infection 

3. Changes in the sense of smell 

4. Tearing eyes 

5. Vision problems

6. Cerebrospinal fluid leak (fluid surrounding the brain)

When to consult a doctor?

After undergoing FESS surgery, patients should closely monitor their recovery for any signs of complications. The following are instances when they should immediately consult their doctor:

1. Fever above 101℉

2. The drainage of clear, watery fluid from the nose

3. Any sudden changes in vision or swelling around the eyes 

4. Intense headache or neck stiffness 

5. Continuous, heavy nasal bleeding that doesn’t improve with decongestant spray use

Delaying FESS, when recommended, can lead to more complex conditions that are harder to manage and treat effectively. These include: 

1. Meningitis (inflammation of the area that surrounds the brain and spinal cord)

2. Intracranial abscess (a collection of pus in the brain caused by an infection)

3. Cavernous sinus thrombosis (a blood clot in the cavernous sinuses)

4. Facial cellulitis (a common bacterial skin infection)

5. Osteomyelitis (infections of the bones)

6. Orbital cellulitis (an infection of the tissues surrounding the eyes)

7. Blindness (infection may spread to the orbital area, affecting vision)

The sinus surgery cost in India varies significantly depending on multiple factors. The price of the endoscopic procedure starts at ₹ 45,000 and goes up to ₹ 1,20,000. The average expense is about ₹ 80,000. 

Note: The figures mentioned above are estimates. For accurate pricing details of the procedure, patients are advised to consult HexaHealth experts. 

The factors that affect this cost include: 

1. Surgeon’s Expertise: The reputation of the surgeon performing the surgery can significantly affect costs. More experienced specialists typically charge higher fees.

2. Hospital or Surgical Facility: Private hospitals are costlier than public centres due to the higher quality of amenities and services provided.

3. Geographic Location: Metropolitan areas are more expensive than smaller towns as the overall costs of living and operational expenses are higher.

4. Other Treatments: If additional procedures, such as septoplasty or turbinate reduction, are needed alongside FESS, they will increase the overall expenditure.

5. Insurance Coverage: The extent to which insurance covers the procedure can also affect the patient’s out-of-pocket costs.

FESS surgery offers a minimally invasive solution for treating chronic sinus issues. It enhances the patient’s quality of life by significantly improving symptoms like congestion and facial pain. The high success rate of the procedure and quicker recovery make it a practical choice for many.

If you or your loved ones are considering sinus surgery, HexaHealth can be your best choice. We help you connect with expert ENT specialists and well-equipped medical facilities. Our team offers dedicated support, from booking appointments to managing aftercare. So, what are you waiting for? Contact us TODAY!