ABSTRACT Objective To determine whether middle meatal spacers reduce postoperative synechiae following endoscopic sinus surgery (ESS) and to compare the effectiveness of absorbable versus nonabsorbable spacer materials. Methods A PRISMA 2020‐guided systematic review and meta‐analysis was performed. PubMed/MEDLINE, Embase, and Web of Science were searched (January 2012–March 2025) for randomized controlled trials in adults undergoing ESS comparing middle meatal spacers versus no‐spacer controls. The primary outcome was synechiae within 3 months. Random‐effects meta‐analysis generated pooled relative risks (RR) with 95% confidence intervals (CI); prespecified subgroup and sensitivity analyses assessed robustness. Results Nine randomized controlled trials comprising 703 patients met inclusion criteria, with eight studies providing dichotomous synechiae data for meta‐analysis. Middle meatal spacers significantly reduced postoperative synechiae compared with no spacer (RR 0.43; 95% CI 0.26–0.71; p = 0.001), with moderate heterogeneity ( I 2 = 52.3%). Absorbable spacers demonstrated a statistically significant protective effect (RR 0.48; 95% CI 0.25–0.93; p = 0.03), whereas nonabsorbable spacers showed a nonsignificant protective trend under random‐effects modeling. No significant difference was observed between absorbable and nonabsorbable spacer subgroups. Trials evaluating steroid‐eluting spacers did not demonstrate clear superiority over nonsteroid absorbable spacers for synechiae prevention. Conclusion Middle meatal spacers reduce postoperative synechiae after ESS, with the most consistent evidence supporting absorbable materials. Given wide variation in baseline synechiae risk, selective rather than routine use is supported.
Chowdhury et al. (Sun,) studied this question.