Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis

Area of Science:

• Otolaryngology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Septoplasty is a common surgical procedure with potential complications including bleeding, pain, and septal perforation.
• Nasal packing is frequently used post-septoplasty to control bleeding and support the septum.
• The optimal method of nasal packing after septoplasty remains a subject of investigation.

Purpose of the Study:

• To systematically review and compare complication rates following septoplasty based on different nasal packing methods.
• To evaluate the efficacy of nonabsorbable nasal packing versus no packing (transseptal sutures or septal splints).

Main Methods:

• A systematic literature search was conducted across PubMed, Embase, and Cochrane Library up to August 2016.
• Twenty randomized controlled trials (RCTs) involving 2,568 patients were included in the meta-analysis.
• Random effect models were utilized to calculate risk differences and risk ratios with 95% confidence intervals.

Main Results:

• No significant differences in bleeding, hematoma, perforation, infection, or residual septal deviation were observed between packing and nonpacking groups.
• The nonpacking group (transseptal sutures or septal splints) showed significantly lower rates of postoperative pain (risk difference -0.50), headache (risk difference -0.42), and synechia (risk difference -0.03).

Conclusions:

• Nonabsorbable nasal packing offers no significant advantage over nonpacking techniques in preventing common septoplasty complications.
• Employing septal splints or transseptal sutures as alternatives to traditional packing can effectively reduce postoperative pain, headache, and synechia after septoplasty.