The comparison of endoscopic septoplasty and conventional septoplasty: A PRISMA analysis.

Objective: Septoplasty is a surgical procedure to correct the deviated nasal septum (DNS). There are two main approaches to address septoplasty - conventional (CS) and endoscopic septoplasty (ES). This study is aimed to compare the perioperative complications following the two techniques, compare postoperative nasal obstruction between the two approaches, and assess the quality of the available evidence.

Methods: A systematic literature search was carried out across multiple databases by independent investigators. We extracted relevant articles that compared conventional septoplasty to endoscopic septoplasty. Cochrane risk of bias tool (RoB2) and Newcastle Ottawa Scale (NOS) was used for the quality assessment of randomized and non-randomized studies, respectively. The objectives comprised immediate surgical complications, surgical length, postoperative nasal obstruction, and quality of life. We incorporated follow-up periods into the univariate meta-regression analyses.

Results: A total of 2055 patients from 28 studies were included in this study. The endoscopic technique showed significantly lower risks of surgical complications. No difference was found in surgical length (3 studies MD 6minutes [95%CI -25-14], P=0.57). Postoperative nasal obstruction was lower in ES but varies with the follow-up periods. Functional assessment scores using NOSE and quality of life were similar between the two approaches. Risk of bias assessment of the included studies showed an overall moderate- to high-risk of bias.

Conclusion: Endoscopic septoplasty demonstrates a lower risk of complications. Long-term benefits of nasal obstruction were likely similar in the two techniques. Further high quality of studies is still warranted, and conclusions should be taken with discretion given the low quality of the included studies in this present meta-analysis.