Endoscopic versus external approach dacryocystorhinostomy: a comparative analysis

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Authors: Rinki Saha, Anuradha Sinha and Jyoti Phukan
Date: May-June 2013
From: Nigerian Medical Journal(Vol. 54, Issue 3)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Clinical report
Length: 3,206 words

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Byline: Rinki. Saha, Anuradha. Sinha, Jyoti. Phukan

Background: Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system. Aim: To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications. Study Design: Prospective non-randomized comparative study. Materials and Methods: Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using ?[sup]2 test. Results: Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively ( P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant ( P = 0.609). Conclusion: Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.

Introduction

Dacryocystorhinostomy (DCR) is an operation that creates a lacrimal drainage pathway into the nasal cavity to facilitate drainage of the previously obstructed excreting system. This operation is indicated for nasolacrimal duct obstruction. The causes of nasolacrimal duct obstruction are idiopathic, iatrogenic, congenital, traumatic, lithiasis and infection. Suspicion of obstruction may be confirmed by syringing, Jones test and dacryocystorhinography (DCG).

Classically, DCR been performed by using an external approach. This was first described by Addeo Toti in 1904. [sup][1] Alternative pathway of DCR by intranasal route was described by Caldwell in as early as 1893. [sup][2] It was modified by West in 1910. [sup][3] Later on, the introduction of rigid nasal endoscopes enabled an endoscopic approach. McDonogh and Meiring first described endoscopic intranasal DCR in 1989. [sup][4] Wormald PJ described powered endoscopic DCR with full sac exposure and primary mucosal anastomosis in 2002. [sup][5]

Although external DCR is still regarded as gold standard, endoscopic DCR is evolving as an equally effective alternative in the recent past. [sup][6] Various studies have showed that success rate for both procedures ranges from 63% to 97%. [sup][7],[8] The wide range of success rate is likely due to surgical variability, patient demographics and lack of standardized outcome measures. [sup][6] With this background, the present study was done with...

Source Citation

Source Citation
Saha, Rinki, et al. "Endoscopic versus external approach dacryocystorhinostomy: a comparative analysis." Nigerian Medical Journal, vol. 54, no. 3, May-June 2013, p. 165. Accessed 5 Feb. 2023.
  

Gale Document Number: GALE|A336775689