Efficacy of Endoscopic Sinus Surgery for Allergic Fungal Rhinosinusitis: A Systematic Review With Meta-analysis.

OBJECTIVE: Endoscopic sinus surgery (ESS) plays a central role in the management of allergic fungal rhinosinusitis (AFRS); however, outcomes vary across studies. The goal of this study is to systematically review and synthesize evidence on the outcomes of ESS in patients with AFRS. DATA SOURCES: PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials. REVIEW METHODS: A systematic search of the literature was conducted from inception to October 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies reporting postoperative outcomes and recurrence following ESS in AFRS were included. RESULTS: Thirty-one studies encompassing 1474 AFRS patients were analyzed. Follow-up durations ranged from 1.5 to 32.5 months (mean = 13.7 months), with substantial variability in postoperative medical therapy. The overall disease recurrence rate was 31% (95% CI, 25%-38%), and the pooled ESS revision rate was 19% (95% CI, 14%-25%). ESS significantly improved sinonasal quality of life, with a pooled reduction in 22-item sinonasal outcome test (SNOT-22) score of 23.37 points (95% CI, 18.71-28.02). Postoperative oral itraconazole use was not associated with a lower recurrence rate (30.7% vs 31.1%, P = .957), nor a lower surgical revision rate (18.2% vs 20.3%, P = .643). CONCLUSION: ESS substantially improves postoperative quality of life in AFRS, with an overall recurrence rate of 31% and surgical revision rate of 19%. Further high-quality studies are needed to define optimal postoperative adjuvant therapy to minimize recurrence and enhance long-term outcomes.