Comparison of Functional Endoscopic Sinus Surgery (FESS) and Nasalisation for Nasal Polyposis: Meta-Analysis and Institutional Perspective from CHUK

Background: Nasal polyposis causes significant morbidity worldwide, often requiring surgery when refractory to medical therapy. While Functional Endoscopic Sinus Surgery (FESS) is considered the global standard, the more radical nasalisation technique remains in use for severe or recurrent disease, particularly in resource-limited settings, such as the Centre Hospitalo-Universitaire de Kamenge (CHUK). Methods: This meta-analysis, aligned with the PRISMA guidelines, compared FESS and nasalisation in adults with nasal polyposis. Systematic searches (PubMed, EMBASE, Cochrane, Web of Science; Jan 1997-Oct 2025) identified comparative studies. Data extraction included design, interventions, outcomes (nasal obstruction, olfaction, facial pain, complications, recurrence, asthma/aspirin intolerance), and risk-of-bias (Newcastle-Ottawa). Pooled odds ratios (OR), standardized mean differences (SMD), absolute risk differences, and I2 for heterogeneity were calculated using random-effects models (RevMan 5.3). Sensitivity, subgroup, and publication bias analyses (Egger’s test) were conducted. Certainty was graded (GRADE). Results: Ten studies (n = 2301) met the inclusion criteria. FESS improved nasal obstruction and olfaction but had higher antrostomy stenosis and synechia. Nasalisation reduced recurrence and facial pain, particularly in asthma/aspirin-intolerant patients. Certainty: moderate (GRADE); risk-of-bias: moderate. Funnel plot revealed minimal publication bias. Conclusion: Both techniques are viable. In the Centre Hospitalo-Universitaire de Kamenge (CHUK)’s modernization pathway, FESS should be the default for most chronic rhinosinusitis with nasal polyps (CRSwNP), contingent on structured training and postoperative protocols; selective nasalisation remains appropriate for aggressive phenotypes and in comorbid asthma/aspirin-intolerant disease. This meta-analysis provides an evidence base for capacity building, knowledge translation, and institutional roadmap design at CHUK.