Patterns and Management of Complications in Elective Septoplasty: A Prospective Longitudinal Study
Ahmad Alkheder, Adel Azar, Said Alkheder, Abdulmajeed YousfanObjective
To prospectively document the incidence, characteristics, and management of intraoperative and postoperative complications in elective septoplasty performed by supervised residents at a university teaching hospital.
Methods
This prospective longitudinal study enrolled 173 consecutive American Society of Anesthesiologists (ASA) class I patients (age 18–60 years) undergoing elective septoplasty at Al-Mouwasat University Hospital, Damascus. Procedures were performed by residents (PGY 3–4) under continuous attending supervision using the closed Killian technique. Postoperative care included intranasal packing removed on day 2 and Silastic splints removed on day 7, with monthly clinical follow-up for 3 months.
Results
The cohort was predominantly male (111/173, 64.2%) with a mean age of 26.01 ± 7.65 years. Mean operative duration was 69.84 ± 23.46 minutes and mean intraoperative blood loss 151.45 ± 97.72 mL. Mucosal lacerations occurred in 139 patients (80.3%), of whom 84.9% required no intervention and 15.1% underwent suturing. Intraoperative bleeding resolved within 10 minutes in all but two cases (1.2%), which required electrocoagulation. Laceration size strongly correlated with blood loss (r = 0.634, p < 0.01). Over three months, no patient developed septal perforation, adhesions, postoperative hemorrhage requiring intervention, abscess, or cerebrospinal fluid leak. Minor events included nasal vestibulitis in two patients (1.16%) and postoperative vomiting in nine (5.2%).
Conclusion
Despite an 80.3% mucosal laceration rate, no major postoperative complication occurred. Prompt intraoperative recognition and selective repair of mucosal tears, rather than their avoidance, appears sufficient to prevent long-term sequelae, even in a supervised resident training setting.