A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy: Scopy-Guided Approach

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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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

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Outcome of primary endoscopic dacrocystorhinostomy with and without stent: a randomised prospective study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175614 ◽

2017 ◽

Vol 4 (1) ◽

pp. 137

Author(s):

Rajesh Pandey ◽

Pramod Kumar Yadav ◽

Amit Kumar Patel ◽

Poonam Rani

Keyword(s):

Success Rate ◽

Surgical Outcome ◽

Nasolacrimal Duct ◽

Sinus Surgery ◽

P Value ◽

Chi Square ◽

Endoscopic Endonasal ◽

Significant Difference ◽

Endonasal Dcr ◽

Endoscopic Dcr

Background: The introduction of endoscopes with different degrees of angulation for endoscopic sinus surgery led to widespread use of endoscopic endonasal DCR (EDCR). The results of EDCR are not only encouraging, but are associated with many other additional advantages. Many modifications like LASER assisted endoscopic DCR, use of silicon tube for stenting, mitomycin-C application etc. have been described. However, insertion of silicon stent in endonasal DCR is most commonly used procedure. Many surgeons claim that use of silicon stent improves success rate of endoscopic DCR. On the other hand, some studies indicate that silicon stent itself is a reason for surgical failure. The present study was done to compare surgical outcome and complication of endoscopic DCR with and without silicon stent. Methods: 70 cases (total 90 EDCR) randomly taken for study. In 35 EDCR cases lacrimal stent were used and in 55 EDCR cases stent were not used. Success rate in both group was analysed using chi-square test. P value <0.05 was considered as significant. Results: We found a success rate of 90.9% and 85.7% for group A (stent not used) and group B (stent used) respectively. The statistic evaluation among these groups does not show any significant difference (p=0.445) which means that insertion of stent in cases of primary EDCR does not significantly change the surgical outcome. Conclusions: Endonasal DCR without silicon stent is considering as effective, safe and minimally invasive primary procedure for treatment of nasolacrimal duct obstruction. Role of using stent in primary EDCR is not very promising because it is not improving the outcome of surgery.

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Endonasal endoscopic dacryocystorhinostomy in Misrata central hospital, Libya

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20180692 ◽

2018 ◽

Vol 4 (2) ◽

pp. 317

Author(s):

Abdussalam M. Jahan ◽

Yousef M. Eldanfur ◽

Abdulhakim Ben Ghuzi

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Success Rates ◽

Central Hospital ◽

Endoscopic Endonasal ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy ◽

Endoscopic Dcr ◽

One Year ◽

The Right

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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Dacryocystorhinostomy Stent Insertion in Initial Endoscopic Dacryocystorhinostomy

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1284 ◽

2016 ◽

Vol 9 (3) ◽

pp. 120-124 ◽

Cited By ~ 6

Author(s):

MM Rajshekar

Keyword(s):

Controlled Trial ◽

Nasolacrimal Duct ◽

Stent Insertion ◽

Stent Group ◽

Excessive Bleeding ◽

Endoscopic Dacryocystorhinostomy ◽

Secondary Hemorrhage ◽

Significant Difference ◽

Endoscopic Dcr ◽

Endoscopic Picture

ABSTRACT Aim To study surgical outcome in dacryocystorhinostomy (DCR) stent insertion in initial endoscopic DCR and the complications associated with the surgery. Study design This is a prospective, single-blinded, randomized, controlled trial. Materials and methods The study was carried in a tertiary level center (period between November 2009 and February 2015). A total of 50 patients with epiphora due to nasolacrimal duct obstruction were divided randomly into two groups – with one group undergoing endoscopic DCR with stent and the other group undergoing endoscopic DCR without stent. The postoperative results were assessed subjectively and objectively after 3 and 6 months and also for complications of the procedure. The results were statistically analyzed by chi-square test. Results There was significant postoperative improvement across all participants and within both groups. A total of 92% of patients in the stent group and 84% of patients in the without stent group improved. There was no significant difference with respect to complications. Synechiae and secondary hemorrhage were the most common complications in the without stent group and stent group respectively. Conclusion The present study shows that statistically significant difference in results is not achieved by inserting stents initially. But, whenever there is excessive bleeding during surgery, which masks endoscopic picture, or when bony stoma created is small because of thick bone and poor access, when atrophic sac is present, or when adhesions are expected due to pus in sac, then stenting should be done without hesitancy. Best time to do stenting is when surgeons’ first think of stenting. Regular postoperative follow-up is necessary as any defect like synechia and granulation tissue formation can be dealt with immediately. How to cite this article Rao SVM, Rajshekar MM. Dacryocystorhinostomy Stent Insertion in Initial Endoscopic Dacryocystorhinostomy. Clin Rhinol An Int J 2016;9(3):120-124.

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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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Mitomycin C–Enhanced Revision Endoscopic Dacryocystorhinostomy

Otolaryngology ◽

10.1177/0194599812450280 ◽

2012 ◽

Vol 147 (5) ◽

pp. 937-942 ◽

Cited By ~ 25

Author(s):

Sameh M. Ragab ◽

Hossam S. Elsherif ◽

Emad M. Shehata ◽

Ahmed Younes ◽

Ahmed M. Gamea

Keyword(s):

Mitomycin C ◽

Controlled Study ◽

Safe Procedure ◽

Endoscopic Dacryocystorhinostomy ◽

Randomized Controlled ◽

Group I ◽

Significant Difference ◽

Endoscopic Dcr ◽

Causes Of Failure

Objectives (1) To conduct an adequately powered randomized controlled trial investigating the safety and efficacy of mitomycin C–enhanced revision endoscopic dacryocystorhinostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. Study Design A randomized controlled study. Setting General hospital. Subjects and Methods Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mitomycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Results Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and complete closure of nasolacrimal stoma with tough fibrous tissue (63%). There was no significant difference between the 2 groups in subjective and objective success rates and adverse events. Group I demonstrated a significantly longer operative time and a significantly lower number of debridement sessions (mean of 1.2 vs 1.9). Conclusions Recurrent nasolacrimal duct obstruction after primary endoscopic DCR is mainly due to reclosure of the nasolacrimal stoma with synechia and fashioning of the small misplaced bony window. Mitomycin C does not increase the success rate of revision endoscopic DCR. It is a safe procedure and may be of value only in patients inaccessible to strict follow-up because it induces a better healing profile in terms of mucosal recovery, wound healing, and less need for debridement sessions.

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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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The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation

Ear Nose & Throat Journal ◽

10.1177/0145561319882123 ◽

2019 ◽

pp. 014556131988212 ◽

Cited By ~ 1

Author(s):

Seyit Mehmet Ceylan ◽

Ceren Erdoğan ◽

Tevfik Sozen ◽

Mahmut Alper Kanmaz ◽

Ilyas Disikirik ◽

...

Keyword(s):

Success Rate ◽

Fibrin Glue ◽

Complication Rate ◽

Anastomosis Group ◽

Lacrimal Sac ◽

Endoscopic Endonasal ◽

Subjective Report ◽

Positive Functional ◽

Surgical Success ◽

Endoscopic Dacryocystorhinostomy

The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients’ subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups ( P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.

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Surgical outcomes of endoscopic dacryocystorhinostomy: analysis of age effect

Scientific Reports ◽

10.1038/s41598-019-56491-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Jae Yun Sung ◽

Yeon Hee Lee ◽

Kyoung Nam Kim ◽

Tae Seen Kang ◽

Sung Bok Lee

Keyword(s):

Success Rate ◽

Age Groups ◽

Nasolacrimal Duct ◽

Age Effect ◽

Adult Patients ◽

Comorbid Conditions ◽

Endoscopic Dacryocystorhinostomy ◽

Average Value ◽

Group 2 ◽

Anatomical Success

AbstractThere is limited evidence in literature determining age effect on outcomes of endoscopic dacryocystorhinostomy (EDCR) in adult patients with primary acquired nasolacrimal duct obstruction (NLDO). We aimed to analyze the outcomes of EDCR according to age in primary acquired NLDO. A retrospective study was performed on consecutive adult patients and patients were divided into two age groups; group 1 (aged to 61 years) and group 2 (aged 62 to 89 years) based on the average value. The minimum required follow-up period was 6 months. A total of 441 EDCRs performed in 342 patients were enrolled. The anatomical success rate was not significantly different between the two groups (91.8% and 88.2%, P = 0.209). However, the functional success rate was significantly lower in the group 2 (85.1% and 76.9%; P = 0.036). Functional failure was associated with old age and a history of diabetes mellitus (P = 0.024 and P = 0.008). In subgroup analysis of patients with anatomical success but functionally failed EDCR, group 2 had significantly more comorbid conditions such as eyelid laxity (P = 0.026). In conclusion, the comorbid conditions which increase with age may affect functional outcome, especially eyelid laxity, careful preoperative examination of the eyelid and conjunctiva should be emphasized to lacrimal surgeons before performing EDCR.

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