Endonasal endoscopic dacryocystorhinostomy in Misrata central hospital, Libya

Background: Dacryocystorhinostomy (DCR) is a surgical procedure performed for the relief of nasolacrimal duct obstruction (NLDO). This procedure involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. It can be performed externally or endoscopically. The aim of this study is to evaluate the success rates and complications of endoscopic dacryocystorhinostomy in Misurata Central Hospital. Methods: Prospective study includes 30 patients admitted to the ENT-Department, Misrata Central Hospital over a period of one year, starting from April 2016 to March 2017. They underwent endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction. Results: Thirty patients were included in the study. Their age ranged from 11-60 years, with mean age of 33 years. Most of the patients were in the age range of 31 to 50 years. There were 24 (80%) females and 6 (20%) males. The most common complaint of patients before surgery was epiphora. There was more obstruction on left side -21 (70%) than on the right side-9 (30%). Bilateral involvement was not seen. Three patients (10%) were required septoplasty during the endoscopic DCR procedure. Twenty four out of thirty (80%) patients had complete resolution. There were no any significant major complications observed in any patient in our study. Conclusions: Endoscopic DCR is safe, successful procedure for the treatment of nasolacrimal duct obstruction and has several advantages over conventional external approach.

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Non endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy

Kathmandu University Medical Journal ◽

10.3126/kumj.v6i4.1731 ◽

1970 ◽

Vol 6 (4) ◽

pp. 437-442 ◽

Cited By ~ 9

Author(s):

BR Sharma

Keyword(s):

Direct Method ◽

Case Series ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Successful Outcome ◽

Success Rates ◽

Endoscopic Endonasal ◽

Duct Obstruction ◽

Surgical Success ◽

External Dacryocystorhinostomy

Aims and Objectives: To compare the success rates of non endoscopic endonasal dacryocystorhinostomy and conventional external dacryocystorhinostomy for the surgical management of primary acquired nasolacrimal duct obstruction. Materials and methods: A retrospective, nonrandomized, comparative interventional case series of 302 patients who underwent either endonasal or external dacryocystorhinostomy over a period of 2 years. All surgeries were performed by a single surgeon and patients with primary nasolacrimal duct obstruction with a minimum of 6 months post operative follow up were included in the study. While external dacryocystorhinostomy was performed using traditional technique, endonasal dacryocystorhinostomy was performed using direct method of nonendoscopic visualization. Results: Of the 302 cases included in the study 165 patients had endonasal dacryocystorhinostomy whereas 137 underwent external dacryocystorhinostomy. Success was defined by resolution of symptoms of tearing, a negative fluorescein dye disappearance test and patency of the canalicular system on lacrimal irrigation. In the external dacryocystorhinostomy group 124 (90.5%) patients had surgical success whereas 146 (88.5%) of the endonasal dacryocystorhinostomy patients had successful outcome. The overall success rate was 89.4%, and the difference of surgical success between the two groups was not statistically significant ( P=0.57). Conclusion: Non endoscopic endonasal dacryocystorhinostomy gives surgical results comparable to those of external dacryocystorhinostomy and is a viable alternative where dacryocystorhinostomy is indicated for primary acquired nasolacrimal duct obstruction. Key words: Endonasal Dacryocystorhinostomy (ENDCR), External Dacryocystorhinostomy (EXDCR), Primary acquired nasolacrimal duct obstruction (PANLDO) doi: 10.3126/kumj.v6i4.1731 Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 437-442

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Successes rate of endoscopic dacryocystorhinostomy at KMC

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i2.3557 ◽

1970 ◽

Vol 8 (2) ◽

pp. 195-198 ◽

Cited By ~ 2

Author(s):

S Shrestha ◽

PK Kafle ◽

S Pokhrel ◽

M Maharjan ◽

KC Toran

Keyword(s):

Success Rate ◽

Symptomatic Relief ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Sinus Surgery ◽

Duct Obstruction ◽

Complete Cure ◽

Endoscopic Dacryocystorhinostomy ◽

Endoscopic Dcr ◽

Sac Syringing

Background: Nasolacrimal duct obstruction is a common problem which can be corrected by dacryocystorhinostomy (DCR). The gold standard treatment for this is DCR operation through an external approach. Development of endoscopic sinus surgery and endoscopic DCR performed through intranasal route is a major recent development in this field. Objectives: The aim of this study is to find out the success rate of endoscopic dacryocystorhinostomy without silicon stent intubation within the period of six month following surgery. Materials and methods: A prospective study was done on 26 patients with obstruction of the nasolacrimal duct referred from eye out-patient department to ENT OPD during one year period from 2008 to 2009. All the cases had undergone endoscopic DCR operation which was regularly followed up for a period of six months. Postoperative patency of ostium was checked by sac syringing and endoscopic visualisation of ostium in the nasal cavity. The success of surgery was categorised as: complete cure, partial cure and no improvement depending upon symptomatic relief and clinical examination such as sac syringing and endoscopic examination following surgery. Result: In six months' follow-up, 22 (84.5%) out of 26 patients had achieved the complete cure and 4 patients (15.5%) continued to have persistent epiphora. Conclusion: Endoscopic DCR is a beneficial procedure for nasolacrimal duct obstruction with no external scar on face and less bleeding. The success rate is as good as external DCR. Key words: Nasolacrimal duct; Epiphora; Rigid nasal endoscope; Endoscopic Dacryocystorhinostomy DOI: 10.3126/kumj.v8i2.3557 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 195-198

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Role of silicone stenting in endoscopic dacryocystorhinostomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200136 ◽

2020 ◽

Vol 6 (2) ◽

pp. 248

Author(s):

Abdussalam M. Jahan ◽

Yousef M. Eldanfur ◽

Abdulhakim B. Ghuzi

Keyword(s):

Success Rate ◽

Medical Center ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

P Value ◽

Success Rates ◽

Duct Obstruction ◽

Significant Difference ◽

Silicone Stent ◽

Endoscopic Dcr

Background: Dacryocystorhinostomy (DCR) is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Closure of the rhinostomy opening was considered a major factor for surgical failure. Use of silicone stent in endoscopic DCR to improve the success rate of the operation have been tried by many surgeons. In this study we assess the success rates of endoscopic DCR with and without silicone stents.Methods: Prospective study includes 30 patients were operated in the Department of ENT, Misrata Medical Center, from April 2017 to March 2018. They underwent endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction. These patients were randomly divided in two groups: A and B with 15 patients in each group. The group A patients underwent endoscopic DCR with silicone stent and group B patients underwent endoscopic DCR without stent. The results were statistically analyzed by chi-square test. Results: 30 patients were included in this study, their age ranged from 17 to 60 years, complaining of epiphora, 24 (80%) were females and 6 (20%) were males. The success rate was higher in patients with silicone stent (93.33%) as compared to patients without silicone stent (86.67%) but this difference in the results is not statistically significant (As p value is 0.542 which is >0.05).Conclusions: Endoscopic DCR is safe, successful procedure for treatment of nasolacrimal duct obstruction and there was no significant difference in the success rates of performing endonasal DCR with silicone or without silicone stents.

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Endoscopic dacryocystorhinostomy with silicon stent: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181872 ◽

2018 ◽

Vol 4 (3) ◽

pp. 785

Author(s):

Neeraj Suri ◽

Bhavya B. M.

Keyword(s):

Cost Effective ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Invasive Technique ◽

Safe Alternative ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy ◽

Endoscopic Dcr ◽

Surgical Modality ◽

External Dcr

Background: Dacryocystorhinostomy is the current surgical modality of treatment preferred for patients with nasolacrimal duct obstruction. Both external and endonasal endoscopic approaches have been in practice with their own merits and demerits. Since the invention of endoscopes, endoscopic DCR is preferred for its scarless, minimally invasive technique and many modifications have been done over years like placement of silicon stents to reduce recurrence.Methods: In our study we evaluated 70 patients with epiphora with obstruction in nasolacrimal duct, Fresh cases and revision cases who had undergone either external and/ endoscopic DCR without stent were included. All patients underwent endoscopic dacryocystorhinostomy (DCR) with silicon stent placement. Patients were followed postoperatively for a period of 6 months to 3 years. Results: The results were compared with that of external DCR and endoscopic DCR without stent. In our study we found that, endoscopic DCR with silicon stent had less chances of recurrence and synechiae formation. Results at 3 years follow up have been good with 95.7% patients relieved of symptoms completely.Conclusions: Endoscopic DCR is a cost effective and a safe alternative for External DCR in patients with nasolacrimal duct obstruction. We found that endoscopic DCR with stenting had several advantages over more conventional external approach.

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Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction

The Journal of Laryngology & Otology ◽

10.1017/s0022215109990776 ◽

2009 ◽

Vol 123 (11) ◽

pp. 1226-1228 ◽

Cited By ~ 12

Author(s):

S Agarwal

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Published Data ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy ◽

External Dacryocystorhinostomy ◽

One Year ◽

Conventional Manner ◽

Gain Access

AbstractObjective:To evaluate the results of endoscopic dacryocystorhinostomy performed to treat acquired nasolacrimal duct obstruction.Design:Retrospective analysis of the outcome of endoscopic dacryocystorhinostomy performed in the conventional manner (i.e. without power instruments or laser) to treat acquired nasolacrimal duct obstruction.Subjects:Outcomes for 300 patients with acquired nasolacrimal duct obstruction were evaluated. Cases with congenital or traumatic blockages were excluded. All the cases were evaluated for nasolacrimal duct blockage by the syringing and regurgitation test. Surgery was performed under local anaesthesia with sedation. Follow up was conducted by syringing and nasal endoscopy, up to one year. Results were compared with published data for endoscopic and external dacryocystorhinostomy.Results:Outcomes were evaluated subjectively using patient symptoms, syringing results and endoscopic appearance. All cases were symptom-free following endoscopic dacryocystorhinostomy. Revision surgery was performed in 18 cases. Stents were placed in 10 patients, of which two developed granulations. Septoplasty was performed in 25 cases to gain access to the lacrimal sac area.Conclusion:The results were comparable with published data for endoscopic and external dacryocystorhinostomy.

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Efficacy of endonasal dacryocystorhinostomy, using ‘cold steel’ instruments without stenting, in treatment of distal nasolacrimal duct obstruction

The Journal of Laryngology & Otology ◽

10.1017/s002221511100017x ◽

2011 ◽

Vol 125 (6) ◽

pp. 590-594 ◽

Cited By ~ 6

Author(s):

L Ananth ◽

P Hosamani ◽

G Chary

Keyword(s):

Complete Resolution ◽

Cost Effective ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Success Rates ◽

Duct Obstruction ◽

Lacrimal System ◽

Reliable Procedure ◽

One Year

AbstractObjective:To assess the efficacy of an endonasal dacryocystorhinostomy technique using conventional instruments, without the use of any adjunctive techniques.Study design:Prospective, non-randomised, cohort study.Methods:Patients diagnosed with nasolacrimal duct obstruction between January 2006 and December 2008 were included in the study. Seventy-eight endonasal dacryocystorhinostomies (primary or revision) were performed with conventional ‘cold steel’ instruments. The technique involved complete exposure and marsupialisation of the lacrimal sac. No adjunctive procedures were used. Success was defined as complete resolution of epiphora and a patent lacrimal system, evaluated by lacrimal irrigation and endoscopy, one year post-operatively.Results:Seventy-four of the 78 cases were symptom-free after a minimum follow up of 12 months, giving an overall success rate of 94.9 per cent. The success rates for primary and revision cases were 95.5 and 90.9 per cent, respectively.Conclusion:Meticulous surgical technique can ensure high success rates with the use of conventional cold steel instruments, without the use of adjunctive procedures, making endonasal dacryocystorhinostomy a cost-effective, reliable procedure.

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Symptom score questionnaire for nasolacrimal duct obstruction in adults--a novel tool to assess the outcome after endoscopic dacryocystorhinostomy

Rhinology Journal ◽

10.4193/rhino10.069 ◽

2010 ◽

Vol 48 (4) ◽

pp. 446-451

Author(s):

G. Smirnov ◽

H. Tuomilehto ◽

H. Kokki ◽

T. Kemppainen ◽

V. Kiviniemi ◽

...

Keyword(s):

Symptom Score ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Subjective Outcome ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy ◽

Glasgow Benefit Inventory ◽

One Year

BACKGROUND: The incidence of nasolacrimal pathway obstruction increases with age, and dacryocystorhinostomy (DCR) is a commonly applied surgical technique to treat severe cases. However, no disease-specific tools to assess the symptoms and the subjective outcome after DCR have been established. We have developed a specific Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire to evaluate the outcome, and tested it in a prospective clinical trial. STUDY DESIGN: Prospective clinical follow-up study. METHODS: Sixty-eight consecutive primary endoscopic dacryocystorhinostomy (EN-DCR) procedures were performed in 64 patients during 2004-2008. Preoperatively and during the three follow-up visits (at 1 week, 2 and 6 months), the patients filled in the NLDO-SS, and at the second and third follow-up visits they also filled in the Glasgow Benefit Inventory (GBI) questionnaire. At one year after the operation, a GBI questionnaire was sent to the patients. RESULTS: The surgical success rate of EN-DCR was 93 %. EN-DCR resulted in a significant reduction in all of the eight symptoms scores of the NLDO-SS (p= 0.001). The GBI scores indicated a significant benefit at 2 months (+37 (SD; 28) and an even higher benefit at 6 months after surgery (+52 (SD; 29), p= 0.001), but no further improvement was found between 6 and 12 months (+52 vs +52, p= 1.0). The correlation between the total GBI and NLDO-SS was significant (p=0.001). CONCLUSIONS: EN-DCR significantly improves the quality of life as measured by the GBI. The NLDO-SS correlated with the GBI and gave more information about the benefits after EN-DCR than GBI alone. The NLDO-SS proved to be an effective tool to evaluate lacrimal obstructions and EN-DCR benefits. Further studies to validate NLDO-SS are needed.

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Primary Endoscopic Endonasal Dacryocystorhinostomy for Pediatric Nasolacrimal Duct Obstruction: A Systematic Review

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4464 ◽

2017 ◽

Vol 31 (5) ◽

pp. 328-333 ◽

Cited By ~ 3

Author(s):

Jeyasakthy Saniasiaya ◽

Baharudin Abdullah ◽

Salina Husain ◽

De Yun Wang ◽

Zahiruddin Wan Mohammad

Keyword(s):

Systematic Reviews ◽

Young Patients ◽

Case Series ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Retrospective Case ◽

Level Of Evidence ◽

Endoscopic Endonasal ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy

Background Epiphora secondary to nasolacrimal duct obstruction is common in the pediatric age group. The mainstay treatment among these young patients has been conservative. Once epiphora becomes recalcitrant, however, an external or an endonasal approach is considered. Objective Endoscopic dacryocystorhinostomy (EDCR) entails creating an opening from the lacrimal sac directly into the nasal cavity to counteract nasolacrimal duct obstruction. We reviewed the literature to determine the effectiveness and the safety of primary EDCR to treat pediatric nasolacrimal duct obstruction. Method A literature search was conducted by using a number of medical literature data bases for the period from 1995 to 2016. The following search words were used either individually or in combination: epiphora, nasolacrimal duct obstruction, endoscopic dacryocystorhinostomy, powered endoscopic dacryocystorhinostomy, laser-assisted endoscopic dacryocystorhinostomy, children, congenital, acquired, presaccal obstruction, and postsaccal obstruction. In addition, a few articles were identified based on the experience and information provided by the senior authors (B.A., S.H., D.Y.W.). The search was conducted over a 1-month period (January 2017). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed when possible. Results Only 10 original clinical research articles were selected based on our objectives and selection criteria. All the studies were at level of evidence III: nonrandomized and noncomparative prospective or retrospective case series. Altogether, 313 patients with ages that ranged from 4 months to 18 years were enrolled. A total of 352 EDCRs were performed that were either single sided (n = 313) or bilateral (n = 39). The most common causes of the obstruction were classified as congenital, followed by idiopathic, and then acquired. A meta-analysis was not performed because of the heterogeneity of the patient groups and variability of the methods used to measure outcomes. Conclusion Analysis of the results indicated that EDCR was an effective, safe therapeutic approach to treating nasolacrimal duct obstruction in pediatric patients. It should be considered as an alternative procedure to external dacryocystorhinostomy after a failed conservative treatment.

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Endoscopic DCR with and without prolene stent in rural area: a prospective randomized study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182718 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1081

Author(s):

Abhay Kumar ◽

Prateek Kumar Porwal ◽

Kailash Prasad Dubey ◽

Harshita Singh

Keyword(s):

Randomized Study ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Successful Outcome ◽

Endoscopic Endonasal ◽

Female Ratio ◽

Duct Obstruction ◽

Chronic Dacryocystitis ◽

Endonasal Dcr ◽

Endoscopic Dcr

Background: The objective of the study was to compare the results of endoscopic DCR with and without prolene stenting and to assess subjective and anatomical success in patients undergoing prolene stenting.Methods: The surgical outcomes of endoscopic endonasal DCR was compared in 100 patients of chronic dacryocystitis with nasolacrimal duct obstruction from June 2013 to May 2018. The successful outcome of surgery was defined by subjective improvement of symptoms and anatomical patency of the neo-ostium on syringing by nasal endoscopy. Results: In our study females were predominant in both groups with around 60% being females in group with stenting and 64% in group without stenting. Male to female ratio was 1:1.5 and 1:1.77 in group with stenting and without stenting. The symptomatic success rate of the surgery at the end of 3 months was 92% in group without stenting and 88% in group with stenting. There was no statistical difference in the results of two groups.Conclusions: We recommend that stenting is not routinely required for endoscopic DCR surgeries. A selective stenting approach may be advocated using prolene 3-0, using stenting for specific indications. With proper surgical technique and good follow up, endoscopic DCR without stenting is treatment of choice for chronic nasolacrimal duct obstruction.

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A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy Scopy-Guided Approach

10.21203/rs.3.rs-307225/v1 ◽

2021 ◽

Author(s):

Akalın İrfan ◽

Ahmet Kalkışım ◽

Hasan Gündoğdu

Keyword(s):

Surgical Intervention ◽

Nasolacrimal Duct ◽

Silicone Tube ◽

Endoscopic Endonasal ◽

New Approach ◽

Surgical Success ◽

Endoscopic Dacryocystorhinostomy ◽

Significant Difference ◽

Endoscopic Dcr ◽

Anatomical Success

Abstract PurposeTo compare and assess classic endoscopic dacryocystorhinostomy (cEDCR) and scopy-guided endoscopic dacryocystorhinostomy (sEDCR) which is a new approach we developed in cases of primary nasolacrimal duct obstruction (PNLDO).MethodsFifty eyes (7 in both eyes) of 43 patients who applied with epiphora and underwent endoscopic DCR and silicone tube implantation between 2015 and 2019 were prospectively studied. cEDCR was performed on 26 of 50 eyes, and sEDCR was performed on 24 of 50 eyes. In sEDCR application, 5 cc non-ionizing opaque material was injected after punctum dilatation, lateral oblique radiographs were taken from the obstructed side with C-arm scope, and the size and location of the lacrimal sac were made visible. Thence, the most appropriate part of the passage was visualized, and surgical intervention was made through this point. Patients were followed in day 1, week 1, 3rd and 6rd mounth. Functional success was assessed according to Munk scoring, and anatomic success was assessed with nasolacrimal lavage. Two groups were compared according to surgical success, time, and complications.ResultsMean age of the cases were 47.85 (±11.8) in the cEDCR group and 54.29 (±16.23) in the sEDCR group. Female and male gender distribution was 21 (80.8%) - 5 (19.2%) for cEDCR and 15 (62.5%) - 8 (37.5%) for sEDCR, respectively. Functional success was spotted as 92.3% in the cEDCR group and 95.8% in the sEDCR group (p:1.0); anatomical success was spotted as 88.5% in the cEDCR group, and 95.8% in the sEDCR group (p:0,611). There was no significant difference between two groups. Mean surgery time was 43 minutes in the cEDCR group and 48 minutes in the EDCR group. Complications were minor and rare (p >0.05). ConclusionAs we are aware of that, our study is the first in literature in which scopy is used in endoscopic DCR. In our study, the sEDCR approach is assessed as a useful modification which improves success and facilitates surgery.

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