Title: Dacryocystorhinostomy (DCR) – Endoscopic versus External approach: A Comparative Analysis

Authors: Dr Jitendra Singh Yadav, Dr Jitendra Kumar, Dr J.P. Purohit, Dr Sylveena Moshahary, Dr Siva Selveraj, Dr Amit Verma

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.09

Abstract

Purpose: To study the duration of surgery, outcomes, adverse events and success rates of external versus endonasal dacryocystorhinostomy (DCR) surgery.

Method: Prospective non-randomized comparative study. Study was conducted for 24 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 Chi-square test.

Result: Functional success and symptomatic relief were equivalent in both procedures. Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR. The follow-up duration was comparable in both groups (mean 6months). Patient satisfaction was significantly higher in the endonasal DCR group.

Conclusion: Endonasal endoscopic DCR surgery offers a very attractive alternative to the well established technique of external DCR surgery for the treatment of primary acquired nasolacrimal duct obstruction with equivalent success rates, shorter surgical time and higher patient satisfaction.

References

  1. Hughes SM. The history of lacrimal surgery.Adv Ophthalmic Plast Reconstr Surg. 1986;5:139–68.
  2. Caldwell GW. Two new operations for obstruction of the nasal duct, with preservation of the canaliculi, and with an incidental description of a new lacrimal probe.Am J Ophthalmol. 1893;10:189–93.
  3. West J. A window resection of the nasal duct in cases of stenosis.Trans Am Ophthalmol Soc. 1910;12:654–8. 
  4. McDonogh M, Meiring H. Endoscopic transnasal dacryocystorhinostomy.Laryngol Otol.1989;103:585–7. 
  5. Wormald PJ. Powered endoscopic    Laryngoscope.  2002;112:69–72.
  6. Tarbet KJ, Custer PL. External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost. 1995;102:1065–70. 
  7. Durvasula V, Gatland DJ. Endoscopic dacryocystorhinostomy: Long-term results and evolution of surgical technique. Laryngol Otol. 2004;118:628–32. 
  8. Karim R, Ghabrial R, Lynch TF, Tang B. A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction.Clin Ophthalmol. 2011;5:979–89
  9. Shun-Shin GA, Thurairajan G. External dacryocystorhinostomy-an end of an era?Br J Ophthalmol. 1997;81:716–7. 
  10. Zhou W, Zhou M, Li Z, Wang T. Endoscopic intranasal dacryocystorhi-nostomy in forty-five patients.Chin Med J (Engl) 1996;109:747–8. 
  11. Hurwitz JJ, Rutherford S. Computerized survey of lacrimal surgery patients. 1986;93:14–9. 
  12. Tan NC, Rajapaksa SP, Gaynor J, Nair SB. Mechanical endonasal dacryocystorh-inostomy-a reproducible technique. 2009;47:310–5. 
  13. Stammberger, H.Endoscopic endonasal surgery: concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique.  Otolaryngol Head Neck Surg. 1986;  94: 147–156
  14. Moras K, Bhat M, Shreyas CS, Mendonca N, Pinto G. External dacryocystorhi-nostomy versus endoscopic dacryocyst-orhinostomy: A comparison.J Clin Diagn Res. 2011;5:182–6.
  15. Gupta S, Goyal R, Thakur AS, Singh H. Conventional dacryocystorhinostomy versus endonasal dacryo-cystorhinostomy - a comparative study.Peoples J Sci Res. 2008;1:1–4.
  16. Caldwell, G.W.Two new operations for obstruction of the nasal duct. N Y Med J. 1893; 57: 581–582
  17. Küpper DS, Demarco RC, Resend R, Anselmo-Lima WT, Valera FC, Moribe I. Endoscopic nasal dacryocystorhinostomy: Results and advantages over the external approach.Braz J Otorhinolaryngol.  2005; 71:356–60. 
  18. Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center.Ophthalmo-logy. 2005;112:1463–8. 
  19. Vishwakarma R, Singh N, Ghosh R. A study of 272 cases of endoscopic dacryocystorhinostomy.Indian J Otolaryngol Head Neck Surg. 2004;56: 259–61.  
  20. Nichlani SS, Jagade MV, Ganeshan A. A comparative study between endoscopic and external approach dacryocystorhin-ostomy.Bombay Hosp J. 2010;52:189–96.
  21. Aslam S, Awan AH, Tayyab M. Endoscopic dacryocystorhinostomy: A Pakistani experience.Pak J Ophthalmol.  2010;26:2–6.
  22. Muscatello L, Giudice M, Spriano G, Tondini L. Endoscopic dacryocystorhin-ostomy: Personal experience.Acta Otorhinolaryngol Ital. 2005;25:209–13.  
  23. Hartikainen J, Antila J, Varpula M, Puukka P, Sepp H, Grénman R. Prospective randomized comparison of endonasal endoscopic dacryocystor-hinostomy and external dacryocystorhi-nostomy.1998;108:1861-6. 
  24. Cokkeser Y, Evereklioglu C, Er H. Comparative external versus endoscopic dacryocystorhinostomy: Otolaryngol Head Neck Surg.2000;123:488–91.

Corresponding Author

Dr Sylveena Moshahary

Junior Resident, Dept of ENT and Head &Neck surgery

MLB Medical College Jhansi