Comparison of Surgical Outcomes and Intraopertive Complications between Endoscopic and Conventional Septoplasty

Abstract Background The nasal septum is essential for nasal stability because it supports the nasal tip, dorsum, and middle nasal third. When the nose is significantly deformed or deviated, it can cause nasal obstruction, a proclivity for chronic or recurring sinusitis, and, less commonly, contact point headaches. Aim of the Work The aim of this study was to compare between endoscopic and conventional septoplasty through a meta-analysis study. Patients and Methods In this meta-analysis we enrolled 22 articles fulfilled inclusion criteria as having symptomatic deviated nasal septum (headache, nasal obstruction, hyposmia and epistaxis) and refractory to medical treatment that diagnosed clinically, radiological and endoscopically having deviated nasal septum or spur. Results Our main finding was that the endoscopic septoplasty technique seemed to offer certain advantages, with fewer overall complications compared with the traditional open technique; According to the study population patients reported better improvement after endoscopic septoplasty over conventional septoplasty regarding: headache (RR = 0.12, 95% CI = 0.05 to 0.18, I2 =0. 01%, P value = 0. 948), nasal obstruction (RR = 0.14, 95% CI = -0.08 to 0.20, I2 = 43.14%, P value = 0. 003),and posterior nasal drip (RR = 0.22, 95% CI = 0.05 to 0.39, I2 = 0%, P value = 0. 921). Endoscopic septoplasty performed much better according to many objective parameters; reduction of turbinates hypertrophy (RR = -0.95, 95% CI = -1.87 to -0.04, I2 = 9.28%, P value = 0. 340), persistent posterior deviation (RR = -1.18, 95% CI = -1.72 to -0.63, I2 = 0%, P value = 0. 920), residual septal deviation (RR =-0.89, 95% CI = -1.31 to -0.48, I2 = 0%, P value = 0. 995), and residual spur (RR = -1.58, 95% CI = -2.39 to -0.76, I2 = 0%, P value = 0. 967). Endoscopic septoplasty was safer than conventional approach in the occurrence of facial swelling (RR = -1.20, 95% CI = -2.00 to -0.40, I2 = 0%, P value = 0. 985), postoperative hemorrhage (RR = -1.18, 95% CI = -1.69 to -0.66, I2 = 0%, P value = 0. 960), mucosal tear (RR = -0.73, 95% CI = -1.08 to -0.37, I2 = 0%, P value = 0. 692), length of postoperative stay (RR = -1.50, 95% CI = -2.07 to -0.93, I2 = 0%, P value = 0. 956), septal hematoma (RR = -1.45, 95% CI = -2.82 to -0.09, I2 = 0%, P value = 1.000), septal perforation (RR = -1.46, 95% CI = -2.61 to -0.31, I2 = 0%, P value = 1.000), nasal pain (RR = -1.02, 95% CI = -1.99 to -0.05, I2 = 0%, P value = 0.984), and synechiae (RR = -1.25, 95% CI = -1.67 to -0.83, I2 = 0%, P value = 0. 761). Conclusion Patients treated with endoscopic septoplasty had better outcome regarding nasal blockage, postnasal drip, headache and septal deviation. Furthermore, Endoscopic septoplasty reported safer result than conventional approach as it reduces residual pain, facial swelling, postoperative hemorrhage, mucosal tear, and length of postoperative stay, septal hematoma, septal perforation, nasal pain, and synechiae.