Strengths and limitations
Our meta-analysis possesses several strengths. Our findings were
comparable to those presented in
the previously published meta-analyses.34–36 Unlike
the preceding meta-analytic publications about
the same topic, the present study included more randomized controlled
trials and other comparative studies which the search had yielded.
Aiming at a better assessment of efficacy and safety, we also added more
parameters for comparison. As much as we could, we held some variable
risk factors constant,
such as the source of the graft tissue and the graft placement method,
to reduce clinical heterogeneity.
Admittedly, our meta-analysis has a few limitations. There was a
noticeable variance in the other risk factors influencing surgical
outcomes (e.g. the age of patients, and the size or location of TM
perforation). This variance resulted in raising concerns about clinical
heterogeneity. Furthermore, publication bias
with highly significant heterogeneity could limit the integrity of our
analytic results regarding operative time and ABGs improvement.
Nevertheless, this study provided results that may be beneficial to
decision-making and outcome prediction in patients receiving ET.