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Hot saline irrigation for haemostasis in functional endoscopic sinus surgery: a systematic review and meta-analysis

Published online by Cambridge University Press:  25 November 2021

D Ranford ,
B Fu ,
P Surda  and
J Rudd
D Ranford*
Affiliation:
Department of Otolaryngology, Guy's and St Thomas’ NHS Foundation Trust, London
B Fu
Affiliation:
Department of Otolaryngology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
P Surda
Affiliation:
Department of Otolaryngology, Guy's and St Thomas’ NHS Foundation Trust, London
J Rudd
Affiliation:
Department of Otolaryngology, Guy's and St Thomas’ NHS Foundation Trust, London
*
Author for correspondence: Dr D Ranford, Department of Otolaryngology, Guy's Hospital, Great Maze Pond, LondonSE1 9RT, UK E-mail: david.ranford@nhs.net
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Abstract

Objective

The aim of this study was to perform a systematic review and meta-analysis of existing evidence on the role of hot saline irrigation in patients undergoing functional endoscopic sinus surgery and its impact on the visibility of the surgical field.

Method

A search of PubMed, Cochrane, Ovid databases and Google Scholar was performed.

Results

Three randomised controlled trials were included. Pooled meta-analysis demonstrated a statistically significant better visibility of the surgical field, and a reduction in total blood loss and operating time during functional endoscopic sinus surgery in the hot saline irrigation group compared with the room temperature irrigation group. Subgroup analysis of studies that did not use vasoconstrictors showed a significant reduction in total blood loss and operating time.

Conclusion

This is the first systematic review that addresses hot saline irrigation for haemostasis in functional endoscopic sinus surgery. The results suggest that hot saline irrigation in functional endoscopic sinus surgery for chronic rhinosinusitis may significantly improve visibility of the surgical field, reduce total blood loss by 20 per cent and decrease operating time by 9 minutes. However, there are limitations of the study because of the significant heterogeneity of the methods, quality and size of the studies.

Keywords

Endoscopic Sinus SurgeryChronic RhinosinusitisIrrigationsHot Saline
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 8 , August 2022 , pp. 676 - 682
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr D Ranford takes responsibility for the integrity of the content of the paper

References

Fokkens, WJ, Lund, VJ, Hopkins, C, Hellings, PW, Kern, R, Reitsma, S et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 2020;58:1–46410.4193/Rhin20.401CrossRefGoogle ScholarPubMed
Alsaleh, S, Manji, J, Javer, A. Optimization of the surgical field in endoscopic sinus surgery: an evidence-based approach. Curr Allergy Asthma Rep 2019;19:810.1007/s11882-019-0847-5CrossRefGoogle Scholar
Albu, S, Gocea, A, Mitre, I. Preoperative treatment with topical corticoids and bleeding during primary endoscopic sinus surgery. Otolaryngol Head Neck Surg 2010;143:573–810.1016/j.otohns.2010.06.921CrossRefGoogle ScholarPubMed
Pundir, V, Pundir, J, Lancaster, G, Kirkland, P, Cornet, M, Lourijsen, E et al. Role of corticosteroids in functional endoscopic sinus surgery - a systematic review and meta-analysis. Rhinol J 2016;54:3–19Google ScholarPubMed
Higgins, TS, Hwang, PH, Kingdom, TT, Orlandi, RR, Stammberger, H, Han, JK. Systematic review of topical vasoconstrictors in endoscopic sinus surgery. Laryngoscope 2011;121:422–32CrossRefGoogle ScholarPubMed
Ko, MT, Chuang, KC, Su, CY. Multiple analyses of factors related to intraoperative blood loss and the role of reverse Trendelenburg position in endoscopic sinus surgery. Laryngoscope 2008;118:1687–9110.1097/MLG.0b013e31817c6b7cCrossRefGoogle ScholarPubMed
Jahanshahi, J, Hashemian, F, Pazira, S, Bakhshaei, MH, Farahani, F, Abasi, R et al. Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial. PLoS One 2014;9:e10447710.1371/journal.pone.0104477CrossRefGoogle ScholarPubMed
Stangerup, S, Dommerby, H, Lau, T. Hot-water irrigation as a treatment of posterior epistaxis. Am J Rhinol 1996;34:18–20Google ScholarPubMed
Özmen, S, Özmen, ÖA. Hot saline irrigation for control of intraoperative bleeding in adenoidectomy: a randomized controlled trial. Otolaryngol - Head Neck Surg 2010;142:893–710.1016/j.otohns.2010.03.010CrossRefGoogle ScholarPubMed
Bakri, YN, Amri, A, Abdul Jabbar, F. Tamponade-balloon for obstetrical bleeding. Int J Gynecol Obstet 2001;74:139–42CrossRefGoogle ScholarPubMed
Gan, EC, Alsaleh, S, Manji, J, Habib, ARR, Amanian, A, Javer, AR. Hemostatic effect of hot saline irrigation during functional endoscopic sinus surgery: a randomized controlled trial. Int Forum Allergy Rhinol 2014;4:877–8410.1002/alr.21376CrossRefGoogle ScholarPubMed
Shehata, A, Ibrahim, M, Abd-El-Fattah, M. Topical tranexamic acid versus hot saline for field quality during endoscopic sinus surgery. Egypt J Otolaryngol 2014;30:327–31CrossRefGoogle Scholar
Al-Ississ, A, Al-Khaldi, H, Maayah, A. Effect of warm saline on bleeding during sinus and septum surgery. J R Med Serv 2016;23:17–21Google Scholar
Stangerup, SE, Thomsen, HK. Histological changes in the nasal mucosa after hot-water irrigation. An animal experimental study. Rhinology 1996;34:14–17Google ScholarPubMed
Thongrong, C, Kasemsiri, P, Carrau, RL, Bergese, SD. Control of bleeding in endoscopic skull base surgery: current concepts to improve hemostasis. ISRN Surg 2013:191543Google ScholarPubMed
Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gøtzsche, PC, Ioannidis, JPA et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700CrossRefGoogle ScholarPubMed
Boezaart, AP, van der Merwe, J, Coetzee, A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 1995;42:373–610.1007/BF03015479CrossRefGoogle ScholarPubMed
Athanasiadis, T, Beule, A, Embate, J, Steinmeier, E, Field, J, Wormald, PJ. Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study. Laryngoscope 2008;118:314–19CrossRefGoogle ScholarPubMed
Higgins, JPT, Altman, DG, Gøtzsche, PC, Jüni, P, Moher, D, Oxman, AD et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d592810.1136/bmj.d5928CrossRefGoogle ScholarPubMed
Moher, D, Cook, DJ, Eastwood, S, Olkin, I, Rennie, D, Stroup, DF. Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement. Lancet 1999;354:1896–900CrossRefGoogle ScholarPubMed
Stelter, K, Theodoraki, MN, Becker, S, Tsekmistrenko, V, Olzowy, B, Ledderose, G. Specific stressors in endonasal skull base surgery with and without navigation. Eur Arch Otorhinolaryngol 2015;272:631–810.1007/s00405-014-3154-8CrossRefGoogle ScholarPubMed
Wormald, PJ, van Renen, G, Perks, J, Jones, JA, Langton-Hewer, CD. The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol 2005;19:514–20CrossRefGoogle ScholarPubMed
Lee, TJ, Huang, CC, Chang, PH, Chang, CJ, Chen, YW. Hemostasis during functional endoscopic sinus surgery: the effect of local infiltration with adrenaline. Otolaryngol Head Neck Surg 2009;140:209–14Google ScholarPubMed
Gan, EC, Habib, ARR, Rajwani, A, Javer, AR. Five-degree, 10-degree, and 20-degree reverse Trendelenburg position during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol 2014;4:61–8CrossRefGoogle ScholarPubMed