Page 76 - Revista Portuguesa - SPORL - Vol 62. Nº1

lengthen the operatory time, yield poorer performed in parallel. One, identified studies
surgical results or even prohibit the relating to FESS and TXA, while the other
completion of the surgery . Some strategies looked for works relating to FESS and HSI. A
1,2
have been tried to ameliorate operating step-by-step approach was used to gather
conditions in FESS . Tranexamic acid (TXA) and original results on FESS related outcomes.
1
hot saline irrigations (HSI) are two potential The search was limited to papers published
interventions to control bleeding and improve in English language. The primary selection
the surgical field quality in this setting 3–14 . was made using any combinations of the
Tranexamic acid is a synthetic amino acid that following terms: "nasal surgery,” tranexamic
works by inhibiting fibrinolysis. It is commonly acid," “hot saline,” “blood loss”, “surgical
applied to reduce bleeding and transfusion field,” and/or “duration”. Bibliographies of the
requirements. In FESS, TXA has been shown included studies were manually checked to
to reduce operative time and complications find additional relevant literature. Finally, the
while increasing surgeon´s satisfaction 3,4,7–14 . explorative results from the two investigators
On the other hand, HSI is a simple and were matched to bring the final research pool.
inexpensive intervention that involves using
warm saline irrigations to increase blood vessel Selection process
constriction and reduce bleeding . Studies Relevant literature was selected in three
1,15
have demonstrated that the use of HSI in main phases (Figure 1). In the wide selection
FESS can significantly reduce operative time phase, exclusion and inclusion criteria were
and complications by improving the quality applied after abstracts´ comprehensive
of the surgical field 3,4,7,15 . Overall, TXA and HSI analysis. Articles addressing unrelated topics
have both been shown to be useful adjuvants or exclusively covering subjective blood
in FESS, without any deleterious effect on loss measurements were excluded. In the
intraoperative hemodynamic stability. These intermediate selection phase, the article's
interventions have been shown to be safe and complete body information was analyzed to
effective and could be considered part of the evaluate inclusion and perform a qualitative
standard of care for FESS in the near future 2,15–19 . analysis. The final sample to be integrated into
Nevertheless, no research to date compares the quantitative analysis was obtained during
these two modalities comprehensively. In this the fine selection phase. At any of the steps,
regard, the main objective of this work was to the paper was disregarded if found to incur
aggregate evidence concerning the effects any of the exclusion criteria (Figure 1).
of TXA and HSI on blood loss, surgical field
visibility and duration of surgery in FESS. Outcomes
The three main outcomes were: volumetric
Material and Methods bleeding loss (vBL), surgical field quality (SFQ)
The review procedure was based on the criteria (also known as intraoperative bleeding score),
for Preferred Reporting Items for Systematic and duration of surgery (DS). Intra-operative
Reviews and Meta-analyses (PRISMA) guidelines. vBL was measured by the amount of blood
One can find the summary of the review process in the suction collector and by measuring
in Figure 1. postoperative weight of dressings. SFQ was
graded in terms of bleeding by means of the
Search strategy Wormald and Boezaart grading scales. DS
21
20
A database search spanning records from was registered in minutes.
January 2000 to December 2022 was
conducted by two Investigators (FS and MS) Assessment of risk of systematic bias
across PubMed and the Cochrane Library. We assessed the methodological quality
Two separate types of investigations were of the included studies and carried out

76 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço