# Effect of Intra-Operative Topical 5-Fluorouracil Post-Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial

## TL;DR

This study found that applying 5-fluorouracil during sinus surgery reduced early postoperative adhesions and improved healing outcomes.

## Contribution

The study introduces the novel use of topical 5-fluorouracil post-FESS to reduce adhesions and improve mucosal healing.

## Key findings

- Test group had significantly higher adhesion rates at one week compared to the control group (32% vs. 11.76%).
- Improvement in smell perception was statistically significant in the test group at 20 weeks post-operatively.
- Mucosal edema, crusting, and nasal discharge improved in both groups over time.

## Abstract

Endoscopic nasal surgery has numerous potential adverse effects, adhesions are at the top of the list. 5-fluorouracil (5-FU), which is an analogue of pyrimidine, is utilized in a wide variety of areas for the purpose of preventing adhesions. In the present investigation, our purpose was to analyze the impact of intra-operative application of 5-flurouracil in the nasal cavity following FESS, as well as to evaluate both subjective and objective outcomes.

Following the acquisition of institutional ethical approval, a testing procedure that was randomized, prospective, and double-blinded was carried out. After the FESS, a cotton swab soaked in 1 mL of 5-flurouracil at 5 mg/mL was inserted in one side of the nasal cavity and a saline-soaked one in the other. Both of these swabs were kept in place for a period of five minutes. Postoperatively, patients were assessed over 6 months duration, wherein, adhesions, discharge, crustation, edema and polypoidal changes were analyzed. Subjective symptoms such as nasal block, nasal discharge and loss of smell were also assessed.

At the one-week follow-up, the test group had a significantly higher incidence of adhesions (32% vs. 11.76%, respectively) (p = 0.004) than the control group. Mucosal edema, crusting, polypoidal change and nasal discharge continued to significantly diminish in both groups. Furthermore, improvement in smell perception in the test group at the 20th week post-operatively was statistically significant (p= 0.014).

Adhesions are less common in the early postoperative period in individuals who underwent FESS with or without polypectomy when 5-FU is administered topically. There is also an improvement in smell perception with a reduction of mucosal edema, crusting, polypoidal change and nasal discharge enabling better healing.