Background: Septoplasty is a common procedure addressing deviated nasal septums for enhanced nasal airflow. Post-surgery, stabilization, and bleeding control are achieved through either nasal packing or septal stitches. The debate persists on their relative effectiveness and safety. This study aims to compare outcomes and risks, including bleeding, pain, septal issues, nasal obstruction, and patient satisfaction, associated with stitches versus nasal packing after septoplasty. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, SCOPUS, Cochrane, and Web of Science, spanning from 2000 to March 2024. The inclusion criteria encompassed randomized controlled trials (RCTs) comparing the use of stitches through the septum and nasal packing in patients undergoing septoplasty. Study quality was evaluated using the Cochrane risk of bias tool. Data synthesis employed a random-effects model, computing Risk Ratios (RRs) or Mean Differences (MDs) with corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran’s Q test and the I2 statistic. Results: 25 RCTs were included, with 22 in the meta-analysis. Stitches through the septum had significantly lower rates of adhesions (RR 2.04, 95% CI 1.19-3.48), hematomas (RR 2.32, 95% CI 1.6-3.42), and nasal crusting (RR 2.86, 95% CI 1.17-6.97) compared to packing. Patients with stitches had significantly less post-op pain (MD 5.43, 95% CI 4.26-6.61). No significant dif-ferences in bleeding, infection, septal perforation, or residual septal deviation. Conclusions: Trans-Septal Suturing showed advantages over packing by reducing post-op morbidities like adhesions, hematomas, crusting, and pain while being as effective for controlling bleeding and septal positioning. However, more high-quality research is needed to guide clinical practice.

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