Sinonasal inverted papilloma (IP) is a benign epithelial tumour which displays aggressive local behaviour, has a high local recurrence rate and the potential for malignant transformation. It is treated by surgical excision which must be thorough to avoid recurrence. Traditionally this was done by an open approach, but since the early 1990's endoscopic techniques have been increasingly employed and are now widely accepted for the treatment of IP. This has led to debate as to whether the access afforded endoscopically is adequate to treat IP without a higher recurrence rate. Studies comparing the recurrence rates of open to endoscopic approaches have shown similar rates but open approaches are usually considered the gold standard for advanced disease, despite the higher morbidity. Reviewing the literature we found that the recurrence rates with endoscopic surgery have improved significantly since the technique was first introduced and conclude that to accurately compare open and endoscopic techniques historical data, from the early days of endoscopic surgery, should be excluded as it does not truly represent the outcome with modern techniques. In doing this it is apparent that endoscopic surgery is the gold standard for the treatment of the vast majority of IP.