Hot Saline Irrigation for Improving Surgical Field Visibility in Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND

Intraoperative bleeding during endoscopic sinus surgery (ESS) impairs visualization and increases operative risks. Hot saline irrigation (HSI) has been proposed as a simple, safe hemostatic adjunct compared with room temperature saline.

OBJECTIVE

To evaluate the effects of HSI versus room temperature saline on surgical field visibility, blood loss, operative duration, and hemodynamic stability in ESS.

METHODS

Systematic review and meta-analysis of randomized and nonrandomized controlled trials identified through PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov up to 30 October 2025. Outcomes were pooled using random-effects inverse-variance models in RevMan 5.4.1 by Cochrane.

RESULTS

Seven studies (n = 453 patients) were included. HSI significantly improved Boezaart bleeding scores (mean difference [MD] -0.68, 95% confidence interval [CI] -1.01 to -0.34; P = .0002; I2 = 79.7%), reduced intraoperative blood loss (MD -56.33 mL, 95% CI -57.22 to -55.44; I2 = 37.1%), and shortened operative time (MD -9.78 minutes, 95% CI -14.62 to -4.94; P < .0001; I2 = 85.0%). No significant difference was observed in mean arterial pressure (MD -0.68 mmHg, 95% CI -2.22 to 0.86; P = .39).

CONCLUSION

HSI significantly enhances surgical field visibility, reduces blood loss, and shortens operative duration during ESS without affecting hemodynamic stability. It represents a safe, low-cost alternative or complement to pharmacological hemostatic agents.