Endoscopic sinus surgery

What is FESS

Functional Endoscopic Sinus Surgery (FESS) is a type of minimally invasive surgery used to treat chronic sinus problems. It aims to improve sinus drainage and function by removing blockages or diseased tissue using a thin telescope called an endoscope.

Why is FESS done

FESS may be recommended if you have:

• Chronic sinusitis not responding to medication.
• Nasal polyps.
• Recurrent sinus infections.
• Sinus symptoms affecting quality of life.
• A structural issue blocking the sinuses.

What does the procedure involve

• FESS is performed under general anaesthetic.
• The surgeon uses an endoscope and fine instruments through the nostrils—no external cuts are made.
• Blocked sinus openings are widened, polyps may be removed, and diseased tissue cleared.
• The procedure usually takes 1–2 hours, depending on the extent of disease.

What to expect after surgery

• Mild nasal bleeding or discharge for a few days.
• Nasal congestion and crusting while healing.
• Some discomfort or pressure in the face.
• You may need time off work for up to 2 weeks depending on your recovery.

Aftercare

• Use saline rinses as your surgical team advises. Use sterile or distilled water, or water that has been boiled and allowed to cool, for nasal rinses. Follow the product instructions and clean the rinse device after use.
• Avoid blowing your nose for at least 1 week.
• Avoid dusty environments and heavy lifting.
• Attend follow-up appointments for nasal cleaning and review.
• Nasal steroid treatment often continues after surgery to control inflammation and reduce recurrence; your team will tell you when to restart it.

Risks and complications

FESS is generally safe but, like all surgery, carries some risks:

• Bleeding.
• Infection.
• Scar tissue or adhesion formation.
• Injury around the eye, including double vision or, very rarely, loss of sight.
• Leakage of cerebrospinal fluid, the fluid surrounding the brain, with a risk of serious infection such as meningitis; this is uncommon.
• Persistent or recurrent symptoms.

Benefits

• Relief from sinus pressure and congestion.
• Reduced infections and need for antibiotics.
• Nasal breathing and smell may improve, but benefit varies and symptoms can return.
• Better quality of life and symptom control.

When to seek medical help

Seek urgent hospital assessment for heavy bleeding, new visual changes or swelling around an eye, severe worsening headache, neck stiffness, fever, or persistent clear watery drainage from one side of the nose.

Call 999 for major bleeding, collapse or severe breathing difficulty.

What surgery can and cannot do

Surgery improves access and drainage but does not necessarily cure the underlying inflammation. Ongoing medicines and follow-up may still be needed. Smell can occasionally worsen, and further surgery is sometimes necessary.