Endoscopic DCR vs external DCR: What's best in the acute setting?

Background: Study conducted to know surgical outcome of combined endoscopic endonasal and subciliary approach in revision DCR cases and complications associated with the procedure.Methods: Prospective, single-blinded, randomized, interventional study is carried out in Tertiary level center from August 2009 to April 2016. Totally 18 patients (11 female and 7 male) were involved in the study who has undergone previous DCR (11 external DCR and 7 endoscopic DCR). The results were analyzed at end of the 3rd and 6th month both subjectively and objectively. Results: All the 18 patients who underwent combined approach were relived from epiphora. None of the patients developed any complications following surgery.Conclusions: The combination of endoscopic and external approach gives benefits of the both approaches giving huge advantages in revision cases. It gives excellent visualization of the surgical field, ability to correct internal nasal pathologies, make clear rhinostoma, workprecisely on fibrosed lacrimal sac and nearly no external scar. It provides good team work opportunity between otorhinologist and ophthalmologist.

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Early bi-canalicular silicone stent intubation in failed DCR with endoscopic visualization: a combined approach

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191619 ◽

2019 ◽

Vol 5 (3) ◽

pp. 613

Author(s):

V. Sreenivas ◽

P. Chaitanya ◽

Manjoo Reddy

Keyword(s):

Complete Resolution ◽

Cost Effective ◽

Early Postoperative Period ◽

College Hospital ◽

Medical College ◽

Cost Effective Method ◽

Silicone Stent ◽

Silicone Intubation ◽

Endoscopic Dcr ◽

External Dcr

Background: Chronic dacryosystitis is a common condition affecting the eye and presenting to ENT surgeons and ophthalmologists, and treated with DCR (dacryocystorhinostomy). In few cases there can be recurrence of symptoms following DCR surgery which can be treated with bi-canalicular silicone intubation. The aim of this study is to assess the effectiveness of an early bi-canalicular silicone intubation in patients with failed DCR using endoscopic visualisation.Methods: This was a prospective observational study. Thirteen cases of DCR operated for chronic dacryocystitis at St John’s Medical College Hospital were reviewed between January 2014 and February 2017. Endoscopic DCR was done for five patients and external DCR for eight patients, number of males were 5 (38%) and females were 8 (62%). Age: 9–73 years (avg: 40.5 years). Results: Nine patients had complete resolution of symptoms following the primary DCR (4 following external DCR and 5 following endonasal endoscopic DCR). Four patients had failed DCR with persistence of watering three months following primary DCR surgery. Re-DCR with bi - canalicular silicon stent intubation was done in failed cases. Postoperative follow up of all the four patients showed complete resolution of symptoms.Conclusions: Failed DCR surgeries can be effectively intubated using bi–canlicular silicon tubes in the early postoperative period following DCR surgery. Silicone tube intubation is the most safe and cost effective method. Endoscopic visualization gives an added advantage of localizing the cause for a failed DCR.

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ENDOSCOPIC DCR VERSUS EXTERNAL DCR

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2015/856 ◽

2015 ◽

Vol 4 (34) ◽

pp. 5854-5858

Author(s):

Rukma Bhandary ◽

Ajay A Kudva ◽

Deepalakshmi Tanthry ◽

Devan P P ◽

Mahesh S G ◽

...

Keyword(s):

Endoscopic Dcr ◽

External Dcr

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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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UK survey of the present role of ear, nose and throat surgeons in lacrimal surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12699663904394 ◽

2010 ◽

Vol 92 (7) ◽

pp. 583-586 ◽

Cited By ~ 3

Author(s):

Salim Al-Shaikh ◽

Faisal Javed ◽

Gregory Fincham ◽

Mohamed Latif ◽

Mahmood Bhutta

Keyword(s):

Response Rate ◽

Postal Survey ◽

Lacrimal Surgery ◽

Perceived Success ◽

Limited Success ◽

Endoscopic Dcr ◽

Nose And Throat ◽

Present Role ◽

External Dcr

INTRODUCTION The objective of this study was to evaluate the current involvement of ear, nose and throat (ENT) surgeons in lacrimal surgery. SUBJECTS AND METHODS A postal survey was distributed to 796 practicing UK consultant otorhinolaryngologists listed at the drfoster website. RESULTS Overall, 531 questionnaires were returned, giving a response rate of 66.7%. Of these, 108 (20.6%) respondents indicated they were involved in lacrimal surgery. The majority of otolaryngologists seem to work in collaboration with ophthalmologists. In our survey, 98% (106) perform endoscopic dacryocystorhinostomy (DCR). Most respondents believed lacrimal intubation and dilation to have limited success, endoscopic DCR to have moderate success and external DCR to have high success. CONCLUSIONS Lacrimal surgery is carried out in a spirit of collaboration with ophthalmologists rather than competition. Endoscopic DCR is the favoured surgical procedure of otolaryngologists. The perceived success rate for endoscopic DCR reported in this survey coincides with that reported in the literature.

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A Comparative Study between Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy – A Hospital-Based Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/522 ◽

2020 ◽

Vol 7 (44) ◽

pp. 2526-2529

Author(s):

Kanishka Chowdhury ◽

Sagar Karmakar ◽

Subhadip Sarkar ◽

Suman Mukhopadhyay

Keyword(s):

Invasive Procedure ◽

External Approach ◽

Medical College ◽

Chronic Dacryocystitis ◽

Group A ◽

Study Population ◽

Endoscopic Dcr ◽

External Dacryocystorhinostomy ◽

Group B ◽

External Dcr

BACKGROUND Dacryocystorhinostomy (DCR) can be performed via two approaches either external approach or endonasally. Earlier, external approach was preferred but with the recent introduction of endoscopy, the focus has shifted to endoscopic DCR as it is a less invasive procedure. This study was conducted to compare both the approaches. METHODS 50 patients were selected from patients attending eye and ENT OPD of a medical college in Kolkata with complaints of watering and / or discharge or with other features of chronic dacryocystitis e.g., mucocele, pyocele etc. They were then allocated in to two groups, group A (patients who will undergo endo DCR) and group B (patients who will undergo external DCR). Results of both were compared. RESULTS The mean age of study population was 34.34 ± 6.65 yrs. Among the study population, 36 patients (72 %) were female and 14 were male (28 %). Mean age of Group A (i.e. patients subjected to endo DCR) was 34.60 ± 5.72, while that of Group B (patients undergone external DCR) was 34.08 ± 7.58 yrs. Patients had a right sided predilection for DCR operation (66 %). Most common presenting symptom was epiphora (66 %) followed by epiphora with discharge. Mean time taken for the operation was significantly (p < 0.0001) more in group B (117 ± 14.43 mins) compared to that in group A (46.60 ± 8.63 mins). Massive intraoperative bleeding was more common in group B (32 %) compared to that in group A (p = 0.0023). Group B had a significantly higher rate of post-operative complications (56 %) compared to that in group A (p = 0.00085). Group B also had a higher success rate compared to group A; but this difference was not significant. (p = 0.22144). CONCLUSIONS Both the approaches have their own merits and demerits; but both are accepted alternatives, so either approach could be performed depending on the situation. KEYWORDS Endoscopic DCR, External DCR, Epiphora

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Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1218 ◽

2015 ◽

Vol 8 (1) ◽

pp. 1-4

Author(s):

NK Mohindroo ◽

Harjitpal Singh

Keyword(s):

Comparative Study ◽

Mitomycin C ◽

Average Hospital ◽

Endoscopic Dacryocystorhinostomy ◽

Group I ◽

Chronic Dacryocystitis ◽

Endoscopic Dcr ◽

External Dacryocystorhinostomy ◽

Group Ii ◽

External Dcr

ABSTRACT A prospective study on 50 cases of chronic dacryocystitis was done to see outcome of management by endoscopic dacryocystorhinostomy (DCR) in Indian population and to look for its advantages or disadvantages over external-DCR. Effect of mitomycin-C was also evaluated in endoscopic DCR cases. Dacryocystitis was diagnosed on the basis of clinical examination by doing regurgitation test and lacrimal syringing. These patients were divided into two groups: group I consisted of those 25 subjects who were planned for endonasal endoscopic DCR and group II of those 25 subjects who underwent external-DCR in ophthalmology department. Of all the cases, maximum number of cases was in the age group of 21 to 35 years, 27 (54%) cases, 88% were females and 12% were males. External-DCR required a relatively longer surgical duration of an average 65 minutes as compared to 35 minutes for endonasal DCR. Average hospital stay for patient in group I was 3 days and it was 7 days in group II. There were minimal intraoperative complications in endoscopic procedure as compared to external-DCR group. Average follow-up was 6 months. Primary success rate was 96% in both the groups. Thus, it was concluded that both the procedures represent good alternatives for the treatment of primary nasolacrimal sac or duct obstruction or chronic dacryocystitis, endoscopic DCR having advantage of less complications and less traumatic. Mitomycin-C was found to be helpful in reducing fibrosis. How to cite this article Singh H, Mohindroo NK. Comparative Study of Endonasal Endoscopic Dacryocystorhinostomy and External Dacryocystorhinostomy. Clin Rhinol An Int J 2015;8(1):1-4.

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Trans Canalicular Diode LASER DCR with ‘Bari Device’ in Pediatric Cases

Journal of Medical Science & Research ◽

10.47648/jmsr.2018.v2902.02 ◽

2018 ◽

Vol 29 (Number 2) ◽

pp. 8-10

Author(s):

Md. B B Bhuiyan ◽

A Akber ◽

M S Islam ◽

K U Chowdhury ◽

M Choudhury

Keyword(s):

Success Rate ◽

Pediatric Patients ◽

Middle Turbinate ◽

Surgical Techniques ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Endoscopic Dcr ◽

External Dcr

Epiphora due to Nasolacrimal duct obstruction (NLDO) is common in chidren. About 5% to 20% infants show evidence of congenital Nasolacrimal duct obstruction with symptoms 1,2. Most of them (95%) cured by conservative management. Majority of the remaining symptomatic patients are cured by probing, repeat probing, probing with incubation and Baloonplasty procedures. About 4% of the patients need surgical intervention. Conventional Dacryocystorhinostomy (DCR) is the main treatment of choice in these cases till to date. DCR means creation of an alternate pathway between lacrimal sac and nasal cavity to drain tear when nasolacrimal duct (NLD) is blocked. There are different surgical techniques available for DCR. These includes conventional or external DCR, endoscopic DCR, endoscopic Laser DCR, transcanalicular or endocanalicular Laser DCR. In adult DCR can be carried out comfortably by the conventional or newly developed endoscopic approach. Narrow space, inadequate development of anatomical landmark makes both the conventional & endoscopic DCR difficult in children. Long term success rate of External DCR in pediatric patients is less in comparison to adult due to vigorous growth of tissue in a child. Laser DCR has been tried but long term success rate is not up to the mark. Several observations like- primary osteum closure, cicatrix formation with middle turbinate and nasal septum, granulation tissue formation- all are more in children due to marked fibroblastic response. So Laser DCR is a challenge in pediatric patients.

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Revision Dacryocystorhinostomy: A Comparison of Endoscopic and External Techniques

American Journal of Rhinology ◽

10.1177/194589240501900319 ◽

2005 ◽

Vol 19 (3) ◽

pp. 322-325 ◽

Cited By ~ 52

Author(s):

Angelo Tsirbas ◽

Garry Davis ◽

Peter J. Wormald

Keyword(s):

Success Rate ◽

Complete Relief ◽

Fisher Exact Test ◽

Success Rates ◽

Exact Test ◽

Endoscopic Techniques ◽

Canalicular Obstruction ◽

Endoscopic Dcr ◽

External Dcr

Background Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the ability of the surgeon to achieve good nasal and lacrimal mucosa apposition. This study evaluates the comparative success rates of the external and endoscopic techniques for revision DCR. Methods Seventeen consecutive revision endoscopic DCRs (average age, 60.9 years) and 13 revision external DCRs (average age, 65.1years) performed from January 1999 to December 2000 performed by separate surgeons were entered into the study. Patients with functional nasolacrimal and canalicular obstruction were excluded. The average follow-up was 11.1 months for the endoscopic DCR group and 10 months for the external DCR group. Results A successful DCR required complete relief of symptoms and an endoscopically determined anatomic patency of the nasolacrimal system. Revision endoscopic DCR surgery was successful in 76.5% of cases (13 of 17 cases) and external DCR surgery was successful in 84.6% (11 of 13 cases). This difference was not statistically significant. (p = 0.64, Fisher exact test with a two-tailed probability). Conclusion Revision endoscopic DCR has a success rate of 76.5%, which compares favorably with that of the revision external DCR (84.6%).

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Comparative Study Of External And Endoscopic Endonasal Dacryocystorhinostomy For The Treatment Of Chronic Dacryocystitis

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v7i2.10389 ◽

2012 ◽

Vol 7 (2) ◽

pp. 15-17 ◽

Cited By ~ 3

Author(s):

MKH Khan ◽

MA Hossain ◽

MJ Hossain ◽

A Al-Masud ◽

MZ Rahman

Keyword(s):

Endoscopic Surgery ◽

Surgical Outcome ◽

Drainage System ◽

Endoscopic Endonasal ◽

Lacrimal Drainage System ◽

Chronic Dacryocystitis ◽

Endonasal Dcr ◽

Endoscopic Dcr ◽

External Dcr ◽

Lacrimal Drainage

Introduction: Dacryocystorhinostomy (DCR) is the treatment of choice for Chronic Dacryocystitis. Although external DCR is still regarded as gold standard for acquired naso-lacrimal duct obstruction, endoscopic DCR is evolving as an equally effective alternative in the recent past. Objective: The study was carried out to compare the surgical outcome of external DCR and endoscopic endonasal DCR for the treatment of Chronic Dacryocystitis. Method: This observational study was carried out in the Department of Ophthalmology, Combined Military Hospital, Dhaka from November 2008 to May 2009. A total of 30 consecutive patients were selected for DCR surgery. Among those 15 patients underwent endoscopic endonasal DCR and 15 under went patients external DCR. Data regarding ocular examination, lacrimal drainage system, per-operative and postoperative complications and ultimate surgical outcome were collected and analyzed. Surgical success was defined by patient's resolution of symptoms with patency of lacrimal drainage system. Failure was defined as no symptomatic reduction in epiphora and/or inability to irrigate the lacrimal drainage system postoperatively. Results: Mean age of the patients was 35.0±11.3 years. Fifty three percent of the study subject was male and 43% of the study subject was female. Accumulated result showed that both surgical approaches had almost similar success rate (endoscopic DCR 73.3% versus external DCR 80%; p=0.666). Complication rate was low and no appreciable difference in complication was marked in both types of surgery. Twenty percent in endoscopic DCR group and 13.3% in external DCR group had moderate bleeding. Two patients (13.3%) of endoscopic surgery required septoplasty. All the complications were managed by conservative treatment. Post operative complication particularly nonpatent lacrimal drainage system occurred to 26.7% of endoscopic group and 20% of those with external DCR surgery. Silicon tube was in situ up to 3 months in all the cases. Ultimate failure occurred in 26.7% for endoscopic DCR and 20% for external DCR. Conclusions: Surgical outcome of both endoscopic and external DCR for Chronic Dacryocystitis was quite satisfactory. Overall complication rate was low. Endoscopic surgery might have an advantage of not having any external scar but it requires high equipment cost and long learning curve. DOI: http://dx.doi.org/10.3329/jafmc.v7i2.10389 JAFMC 2011; 7(2): 15-17

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