OBJECTIVE The aim of this study was to investigate the effectiveness of endoscopic surgery for recurrent sinonasal inverted papilloma and evaluate the recurrence rates of endoscopic and open resection at a single institution. METHODS This retrospective study was performed on 21 patients with histopathologically confirmed recurrent sinonasal inverted papilloma who underwent an operation in our department from January 1990 to January 2005. The 21 recurrent cases were categorized according to the Krouse staging system into 1 case of stage 1 (5%), 18 cases of stage 2 (85%), 2 cases of stage 3 (10%), and 0 cases of stage 4 (0%). There were 7 patients (33%) who underwent endoscopic resection and 14 patients (67%) who underwent open resection. RESULTS Of the 21 recurrent patients who underwent resection, 4 patients (19%) were found to have recurrence. The mean time to recurrence was 28 months. The recurrence rates of the patients with stage 1, stage 2, and stage 3 were 0%, 17%, and 50%, respectively (P < 0.05). Recurrence was observed in 1 patient (14%) in the endoscopic group and 3 patients (21%) in the open group (P > 0.05). There was statistical difference in recurrence rates between stage 1 and stage 2 in the endoscopic group (P < 0.05) and between stage 2 and stage 3 in the open group (P < 0.05). There was no significant difference in recurrence rates between the endoscopic and the open group in stage 2 (P > 0.05). CONCLUSIONS Endoscopic and open approaches are both available to achieve radical excision of the recurrent sinonasal inverted papilloma, with similar rates of recurrence. The risk for recurrence is likely related to the Krouse stage of the tumor, with more aggressive tumors having a higher propensity for recurrence. Endoscopic surgery is an effective treatment of recurrent sinonasal inverted papilloma.