The effects of various drug irrigation in post operative endoscopic sinus surgery patients: A systematic review and network meta-analysis

BACKGROUND: This article aims to systematically analyze the therapeutic effects and safety of different irrigation drugs on patients after functional endoscopic sinus surgery (FESS). METHODOLOGY: We searched the PubMed, Web of Science, The Cochrane Library and Embase databases for randomized controlled trials (RCTs). Two reviewers independently screened the literature and extracted data. Data analysis was performed using R 4.3 software, and the risk of the studies was evaluated through ROB2. RESULTS: 18 RCTs were included in this study. Compared with normal saline (MD = -9.04, 95%CI -14.05 to -4.02) and xylitol solution (MD = -18.94, 95%CI -33.79 to -4.08), the steroid solution was more effective. In reducing the postoperative SNOT-22 score, the steroid solution ranked first. For the Lund-Kennedy endoscopic score and the NOSE score, there was no significant difference in the efficacy among various solutions. Compared with normal saline (MD = -13.58, 95%CI -22.03 to -5.13) and hypertonic saline (MD = -9.06, 95%CI -17.48 to -0.63), Ringer's lactate solution was more effective. In reducing the postoperative SNOT-20 score, Ringer's lactate solution ranked first. CONCLUSION: Compared with other irrigation drugs, the steroid solution is more recommended for nasal irrigation after FESS. Considering the limitation of our article, in order to draw more instructive conclusion we need more high-quality multicenter RCTs.