Endoscopic Sinus Surgery test
Your doctor has suggested you have endoscopic sinus surgery as part of your treatment. Functional endoscopic sinus surgery (FESS) has become the accepted standard approach and technique when surgical treatment of sinusitis is indicated.

Functional endoscopic sinus surgery test(FESS)
FESS is a minimally-invasive approach to the sinus cavities using endoscopes (telescopes) to view the important structures of the nose and sinuses. The endoscope is inserted through the nose. The view with the endoscope allows for better identification of the underlying disease, which in turn allows the surgeon to be precise, careful, and thorough with minimal damage to normal surrounding tissue. All four sets of sinuses can be viewed directly during FESS and obstructing tissue or disease removed as indicated. FESS allows for less tissue removal, more rapid tissue healing, and shorter recovery periods. The surgery is often performed on an outpatient basis.

When FESS is Indicated
Most commonly FESS is indicated for people with chronic sinus problems who do not respond to medical treatments.

The diagnosis of chronic sinusitis is based on symptoms, nasal examination (i.e., nasal endoscopy), sinus CT findings, and response to previous treatments. The majority of ppeople with sinusitis do not require surgery. However, in some people symptoms persist despite prolonged medical treatments and FESS is indicated to help control the problem. With proper patient selection and evaluation, research has proven FESS to be 70-90% successful in improving symptoms of sinusitis and related nasal and sinus problems. FESS is not a “cure” for sinusitis, but is helpful in managing symptoms of the chronic nature of the disease. The most common indications for FESS include chronic infection, nasal obstruction or blockage and nasal polyps.

Getting Ready for the Test
Your surgery will take place at Saint Joseph Hospital. You will receive information from National Jewish Health and Saint Joseph Hospital on preparing for surgery. Follow these instructions closely or your surgery may need to be cancelled.

Your doctor may prescribe medicine to help improve the condition of your sinuses before your surgery. These medicines may include antibiotics or oral steroids. If your doctor prescribes medicine before surgery, make sure to start them on the correct day and take them as ordered.

Avoid taking the following medicine for at least 10 days prior to surgery:

Aspirin
Motrin®, Advil® (ibuprofen)
Aleve® (naproxen)
Other non-steroidal anti-inflammatory medicine (NSAIDS)
Vitamin E (multivitamin is fine)
Gingko biloba, garlic, ginseng
These medicines can thin the blood and create excessive bleeding during and after surgery. Tylenol is safe and can be taken up to the day of surgery.

If you smoke, it is critical that you try to give up smoking for at least 4 weeks prior to surgery, and at least 4 weeks after surgery. Smoking during this critical time can seriously interfere with the success of the surgery. It may result in excessive scarring and failure of the surgery. Ask your health care provider about resources to help you give up smoking.

Inform your primary care doctor that you are planning to have sinus surgery. Your doctor can help make sure that you are medically cleared for surgery. Most of the pre-operative testing will be done at National Jewish Health. We may need you to request old records from you primary care doctor.

You will also receive information on preparing the day before surgery. Make sure to read this carefully.

During the test
In most cases you will receive general anesthesia for your surgery. With general anesthesia, you will be asleep for the entire surgery.

We often do not use nasal packing during sinus surgery to decrease discomfort. If bleeding occurs that is difficult to control, packing will be placed. It would then be removed within 1 to 3 days after the surgery. Newer packing materials that the body absorbs may also be used in select cases. This means the packing does not need to be removed.

When your surgery is over, you will spend one to two hours in the recovery area. Most people feel well enough to go home the day of surgery. Some people may require a one night stay in the hospital. This may be true if extra recovery time is needed or if they have other medical problems that require special medical attention.

After the test
Follow-up visits often take place at 1 week, 3 weeks and 6 weeks after surgery. This may be adjusted slightly. After these visits, we often recommend you return every 3 months until your condition is stable and your symptoms improve.

You will receive prescriptions for pain medicine right after surgery. You may also receive medicine for oral steroids (decrease swelling) and antibiotics.

Do not blow your nose for the first week following surgery.

You will often start nasal saline washes of the nose twice a day starting 24 to 48 hours after surgery.

Avoid exercise and limit any exertion for at least 2 week following surgery. This includes no bending, lifting (more than 10 pounds) or straining. Your surgeon will be able to advise you when it is safe to begin exercising again.

Plan on taking about 1 week off from work to recover from surgery.

Do not fly anywhere for 2 weeks, SCUBA dive for 4 weeks or swim for 2 weeks.

Risks of FESS
As with any surgical procedure, FESS has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

Bleeding: Most sinus surgery involves some degree of blood loss, which is generally well tolerated by the patient. If there is significant bleeding the may need to stop the surgery. Although most patients do not require nasal packing, a few patients will require a small nasal pack to be removed 1-3 days after surgery. Minor dripping of blood for 1 to 2 days following surgery is normal. Blood transfusion is very rarely necessary and is given only if the patient’s health would otherwise be compromised.

Recurrence of disease: Although FESS provides significant symptomatic benefits for the vast majority of patients, surgery is not a cure for most forms of sinusitis. Therefore, you can expect to continue with your sinus medications even after successful sinus surgery, although in general your requirements for such medications should be lessened. In some instances, additional “touch-up” surgery may be necessary to optimize your surgical outcome. This may be necessary in 5-10% of cases.

Spinal fluid leak: The sinuses are located near the brain. This means there is a rare chance of creating a leak of spinal fluid (the fluid surrounding the brain) or injuring the brain. Also called a cerebrospinal fluid (CSF) leak, the reported incidence of this is less than 1% of cases. Should the rare complication of a CSF leak occur, it may create a potential pathway for infection, which could result in meningitis. If a CSF leak were to occur, it might require surgical closure and extend your hospitalization.

Visual problems: There have been isolated reports of visual loss after sinus surgery. The potential for recovery in such cases is not good. In addition, orbital (eye) injury resulting in double vision, blurring vision, or excessive tearing from the eye are additional potential complications. Fortunately, such a complication is rare. The reported incidence is less than 1% of cases.

Other risks: Other uncommon risks of surgery include alteration of sense of smell or taste; persistence and/or worsening of sinus symptoms and facial pain and swelling or bruising of the area around the eye.

Septoplasty at the same time: Some patients have a deviation of the nasal septum. This is corrected at the time of surgery through a short procedure called septoplasty. If you require septoplasty, there are additional risks. The main risks are:

Bleeding or infection in the area of the septum
Numbness of the front teeth
Development of a hole through the septum (septal perforation)
Recurrence of septal deviation
There is a very small risk if these risks happen it could change the appearance of the nose.

Endoscopic Sinus Surgery test
Your doctor has suggested you have endoscopic sinus surgery as part of your treatment. Functional endoscopic sinus surgery (FESS) has become the accepted standard approach and technique when surgical treatment of sinusitis is indicated.

Functional endoscopic sinus surgery test(FESS)
FESS is a minimally-invasive approach to the sinus cavities using endoscopes (telescopes) to view the important structures of the nose and sinuses. The endoscope is inserted through the nose. The view with the endoscope allows for better identification of the underlying disease, which in turn allows the surgeon to be precise, careful, and thorough with minimal damage to normal surrounding tissue. All four sets of sinuses can be viewed directly during FESS and obstructing tissue or disease removed as indicated. FESS allows for less tissue removal, more rapid tissue healing, and shorter recovery periods. The surgery is often performed on an outpatient basis.

When FESS is Indicated
Most commonly FESS is indicated for people with chronic sinus problems who do not respond to medical treatments.

The diagnosis of chronic sinusitis is based on symptoms, nasal examination (i.e., nasal endoscopy), sinus CT findings, and response to previous treatments. The majority of ppeople with sinusitis do not require surgery. However, in some people symptoms persist despite prolonged medical treatments and FESS is indicated to help control the problem. With proper patient selection and evaluation, research has proven FESS to be 70-90% successful in improving symptoms of sinusitis and related nasal and sinus problems. FESS is not a “cure” for sinusitis, but is helpful in managing symptoms of the chronic nature of the disease. The most common indications for FESS include chronic infection, nasal obstruction or blockage and nasal polyps.

Getting Ready for the Test
Your surgery will take place at Saint Joseph Hospital. You will receive information from National Jewish Health and Saint Joseph Hospital on preparing for surgery. Follow these instructions closely or your surgery may need to be cancelled.

Your doctor may prescribe medicine to help improve the condition of your sinuses before your surgery. These medicines may include antibiotics or oral steroids. If your doctor prescribes medicine before surgery, make sure to start them on the correct day and take them as ordered.

Avoid taking the following medicine for at least 10 days prior to surgery:

Aspirin
Motrin®, Advil® (ibuprofen)
Aleve® (naproxen)
Other non-steroidal anti-inflammatory medicine (NSAIDS)
Vitamin E (multivitamin is fine)
Gingko biloba, garlic, ginseng
These medicines can thin the blood and create excessive bleeding during and after surgery. Tylenol is safe and can be taken up to the day of surgery.

If you smoke, it is critical that you try to give up smoking for at least 4 weeks prior to surgery, and at least 4 weeks after surgery. Smoking during this critical time can seriously interfere with the success of the surgery. It may result in excessive scarring and failure of the surgery. Ask your health care provider about resources to help you give up smoking.

Inform your primary care doctor that you are planning to have sinus surgery. Your doctor can help make sure that you are medically cleared for surgery. Most of the pre-operative testing will be done at National Jewish Health. We may need you to request old records from you primary care doctor.

You will also receive information on preparing the day before surgery. Make sure to read this carefully.

During the test
In most cases you will receive general anesthesia for your surgery. With general anesthesia, you will be asleep for the entire surgery.

We often do not use nasal packing during sinus surgery to decrease discomfort. If bleeding occurs that is difficult to control, packing will be placed. It would then be removed within 1 to 3 days after the surgery. Newer packing materials that the body absorbs may also be used in select cases. This means the packing does not need to be removed.

When your surgery is over, you will spend one to two hours in the recovery area. Most people feel well enough to go home the day of surgery. Some people may require a one night stay in the hospital. This may be true if extra recovery time is needed or if they have other medical problems that require special medical attention.

After the test
Follow-up visits often take place at 1 week, 3 weeks and 6 weeks after surgery. This may be adjusted slightly. After these visits, we often recommend you return every 3 months until your condition is stable and your symptoms improve.

You will receive prescriptions for pain medicine right after surgery. You may also receive medicine for oral steroids (decrease swelling) and antibiotics.

Do not blow your nose for the first week following surgery.

You will often start nasal saline washes of the nose twice a day starting 24 to 48 hours after surgery.

Avoid exercise and limit any exertion for at least 2 week following surgery. This includes no bending, lifting (more than 10 pounds) or straining. Your surgeon will be able to advise you when it is safe to begin exercising again.

Plan on taking about 1 week off from work to recover from surgery.

Do not fly anywhere for 2 weeks, SCUBA dive for 4 weeks or swim for 2 weeks.

Risks of FESS
As with any surgical procedure, FESS has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

Bleeding: Most sinus surgery involves some degree of blood loss, which is generally well tolerated by the patient. If there is significant bleeding the may need to stop the surgery. Although most patients do not require nasal packing, a few patients will require a small nasal pack to be removed 1-3 days after surgery. Minor dripping of blood for 1 to 2 days following surgery is normal. Blood transfusion is very rarely necessary and is given only if the patient’s health would otherwise be compromised.

Recurrence of disease: Although FESS provides significant symptomatic benefits for the vast majority of patients, surgery is not a cure for most forms of sinusitis. Therefore, you can expect to continue with your sinus medications even after successful sinus surgery, although in general your requirements for such medications should be lessened. In some instances, additional “touch-up” surgery may be necessary to optimize your surgical outcome. This may be necessary in 5-10% of cases.

Spinal fluid leak: The sinuses are located near the brain. This means there is a rare chance of creating a leak of spinal fluid (the fluid surrounding the brain) or injuring the brain. Also called a cerebrospinal fluid (CSF) leak, the reported incidence of this is less than 1% of cases. Should the rare complication of a CSF leak occur, it may create a potential pathway for infection, which could result in meningitis. If a CSF leak were to occur, it might require surgical closure and extend your hospitalization.

Visual problems: There have been isolated reports of visual loss after sinus surgery. The potential for recovery in such cases is not good. In addition, orbital (eye) injury resulting in double vision, blurring vision, or excessive tearing from the eye are additional potential complications. Fortunately, such a complication is rare. The reported incidence is less than 1% of cases.

Other risks: Other uncommon risks of surgery include alteration of sense of smell or taste; persistence and/or worsening of sinus symptoms and facial pain and swelling or bruising of the area around the eye.

Septoplasty at the same time: Some patients have a deviation of the nasal septum. This is corrected at the time of surgery through a short procedure called septoplasty. If you require septoplasty, there are additional risks. The main risks are:

Bleeding or infection in the area of the septum
Numbness of the front teeth
Development of a hole through the septum (septal perforation)
Recurrence of septal deviation
There is a very small risk if these risks happen it could change the appearance of the nose.


एंडोस्कोपिक रेट्रोग्रेडेड चोलॅंगियोपॅक्रेट्रोग्राफी (ईआरसीपी) चाचणी?

ईआरसीपी ही नैदानिक ​​आणि उपचारात्मक प्रक्रिया आहे जी लज्जास्पद लवचिक ट्यूब आणि एक्स-रे वापरते जी पित्त, पॅनक्रिया आणि पित्ताशयाची छोटी छोटी आतड्यांमधून बाहेर पडणार्या पित्त आणि अग्नाशयी नलिका तपासण्यासाठी वापरली जाते.

ईआरसीपी प्रक्रिया दरम्यान, आपला चिकित्सक आपल्या तोंडातून, एसोफॅगस आणि पोटातून ड्युओडेनममध्ये किंवा लहान आतडेच्या वरच्या भागाद्वारे एन्डोस्कोप किंवा संकीर्ण प्लास्टिक ट्यूबमधून जातो. हळूहळू कॉन्ट्रास्ट सामग्री म्हणून डाई टाकल्यानंतर, आणि फ्लोरोस्कोपी (एक्स-रे) च्या सहाय्याने, डॉक्टर कोणत्याही पत्थर, संकोचन किंवा इतर असामान्यतांसाठी पित्त आणि अग्नाशयी नलिकांचा अभ्यास करू शकतात.

जर आपल्याला वेदना होत असेल किंवा असामान्य लॅब (यकृत किंवा पॅनक्रिया रक्त तपासणी) आणि / किंवा इमेजिंग चाचणी (सीटी किंवा एमआरआय स्कॅन) परिणाम प्राप्त झाल्यास आपले डॉक्टर ईआरसीपी प्रक्रियाची शिफारस करू शकतात. या रोगाचा उपयोग बॅलीरी किंवा अग्नाशयी रोगाचे निदान करण्यासाठी केला जातो ज्यामध्ये रोगाचा सौम्य आणि घातक उद्गम, किंवा इटिओलॉजी यांचा समावेश होतो. ज्या रुग्णांना जांडयुक्त (त्वचा आणि डोळे यांचे पिवळ्या रंगाचे विरघळवणे) केले जाते त्यांना देखील प्रक्रियेतून जाण्याचा सल्ला दिला जाऊ शकतो. याव्यतिरिक्त, शस्त्रक्रिया आवश्यक आहे काय हे निर्धारित करण्यासाठी एक ईआरसीपी चाचणी वापरली जाते.

प्रगत एन्डोस्कोपर्स ब्रेल नलिकातील दगड क्रश करण्यासाठी किंवा काढून टाकण्यासाठी किंवा अरुंद नलिका वाढविण्यासाठी स्टेंट ठेवण्यासाठी ईआरसीपी प्रक्रिया दरम्यान विविध चिकित्सेच्या तंत्रज्ञाने करू शकतात. ते नलिकातून बायोप्सी किंवा ऊतींचे नमुने देखील कॅन्सरसारख्या काही वैद्यकीय परिस्थितींचे निदान करण्यासाठी घेऊ शकतात.

ईआरसीपी प्रक्रियेसाठी कशी तयार करावी?
- ईआरसीपी चाचणीपूर्वी आठवड्यात आपल्याला आहार आणि / किंवा औषधे प्रतिबंध असू शकतात. कृपया आपल्या डॉक्टरांना तपशीलवार सूचनांसाठी विचारा. आपण कोणत्याही प्रकारचे रक्त पातळ करणारे औषध घेतल्यास आपल्या डॉक्टरांना याची खात्री करुन घ्या.
- प्रक्रिया, प्रकाश जेवण किंवा अपारदर्शी द्रवपदार्थांपूर्वी कमीतकमी 8 तास आधी आपल्याला 6 तासांपूर्वी कोणतेही द्रव्य जेवण दिले जाणार नाही किंवा कमीतकमी 2 तास आधी द्रव साफ केले जाणार नाही.
- कामातून दिवस काढून टाकण्याची योजना.
- आपण ओळखत असलेल्या कोणालातरी घरी चालविण्याची योजना करा. प्रक्रिया सामान्य ऍनेस्थेसियामुळे केली गेली असल्याने, प्रक्रिया नंतर चालविण्यास किंवा दुसऱ्या दिवशी कामावर परत जाण्याची आपल्याला परवानगी दिली जाणार नाही.
आपल्या वैद्यकाला कोणत्याही विशिष्ट गरजा, वैद्यकीय परिस्थिती, एलर्जी (जसे की लेटेक्स) आणि आपण घेत असलेल्या सर्व वर्तमान औषधाबद्दल माहिती द्या. काही प्रकरणांमध्ये, - आपला डॉक्टर प्रक्रियापूर्वी अँटीबायोटिक ठरवू शकतो.
- नॉर्थशोर जीआय लॅब आपल्यास असलेल्या कोणत्याही प्रश्नांची उत्तरे देण्याच्या प्रक्रियेपूर्वी संध्याकाळी आपल्याशी संपर्क साधण्याचा प्रयत्न करेल.
- काही प्रकरणांमध्ये, जेव्हा एखाद्या ईआरसीपी प्रक्रिया दरम्यान रुग्णांना काही उपचारात्मक हस्तक्षेपांची आवश्यकता असते तेव्हा त्यांना निरीक्षणासाठी रात्रीच्या वेळी रूग्णालयात दाखल केले जाऊ शकते.
- एकदा आपण ईआरसीपी प्रक्रियासाठी आल्यावर एकदा काय अपेक्षा करावी.
- आपल्या शेड्यूल केलेल्या प्रक्रियेच्या वेळापूर्वी 30 मिनिटापर्यंत पोहोचाण्याची योजना.
- आपणास एक अनैच्छिक ओळ दिली जाईल कारण प्रक्रिया ऍनेस्थेसियासह केली जाते.
- ऍनेस्थेसियाविषयी आपल्याकडे असलेल्या कोणत्याही प्रश्नांची किंवा समस्येचे निराकरण करण्यासाठी अॅनेस्थेसिओलॉजिस्ट आपल्याशी भेटेल.
- प्रक्रियेनंतर घरी जाण्यासाठी कोणी उपलब्ध असेल तर आपल्याला विचारले जाईल.
- आपल्या डोक्यावर उजवीकडे वळल्यावर आपल्या पोटावर आपल्याला ठेवण्यात येईल.
- बर्याच बाबतीत, प्रक्रिया 90 मिनिटे लागतात.
- ईआरसीपी प्रक्रिया नंतर काय अपेक्षा करावी
- प्रक्रिया पूर्ण झाल्यानंतर, आपण सुमारे 60 ते 90 मिनिटांसाठी पुनर्प्राप्त कराल.
- आपणास गलेचा त्रास होऊ शकतो.
- एकदा आपण डिस्चार्ज निकष पूर्ण केले की, आपला चिकित्सक आपल्याबरोबर प्राथमिक निष्कर्षांवर चर्चा करेल आणि आपल्याला अतिरिक्त चाचणी घेण्याची आवश्यकता असल्यास आपल्याला कळवेल. आपण आपल्या नेहमीच्या औषधे घेतल्यानंतर पुन्हा सुरु करू शकता.
- जर आपण निरीक्षणासाठी रुग्णालयात दाखल न झाल्यास, आपल्याला घरी घेऊन जाण्यासाठी डिस्चार्ज निर्देश प्राप्त होतील.
- परीक्षांच्या निष्कर्षांवर अवलंबून काही रुग्णांना आहार आणि / किंवा औषध प्रतिबंध दिले जाऊ शकतात.
- प्रक्रियेनंतर आपल्याला चालविण्याची परवानगी दिली जाणार नाही.