Comparative Study between Endonasal Endoscopic and Conventional Dacryocystorhinostomy

Abstract

The present study was designed to compare the outcome results of nasal endoscopic and conventional dacryocysto-rhinostomy (DCR). It included 40 patients with nasolacrimal duct (NLD) obstruction, selected from Al-Azhar University Hospital (New Damietta), through two years period, extending from July 2010 to July 2012. They were divided into two equal groups according to the planned surgical intervention technique Group 1: included 20 patients with NLD obstruction who were underwent external surgical DCR. Group 2: included 20 patients with NLD obstruction who underwent nasal endoscopic DCR. All cases underwent full history taking, clinical examination, laboratory investigations; surgical intervention and follow up for about 6 months postoperatively. Results of the present study revealed the following data: • Age ranged from 10 to 60 years with a mean of 34.15±11.78 years. • Males were 13 cases, representing 32.5% and females were 27 cases (67.5%) • NLD obstruction was on the right side in 18 cases (45.0%) and on the left side in 22 cases (55.0%) • Operative time ranged from 30 minutes to 120.0 minutes with a mean of 65.90±31.68 minutes; and there was significant decrease of operative time in endoscopic DCR in comparison to external DCR (35.20±3.80 vs 96.60±7.89 minutes respectively). • Intraoperative bleeding ranged from 20 to 160 cc with a mean of 80.12±48.53 cc; and there was statistically significant decrease of intraoperative bleeding in endoscopic DCR group in comparison to external DCR (35.00±9.86 vs 125.25±21.24 CC respectively). • 85% of studied cases had no intraoperative complications (80.0% in external DCR and 90.0% in endoscopic DCR). Reported complications included prolapse of periorbital fat in 2 cases (5.0%) (All were in endoscopic group); damage of the sac wall in 2 cases (5%) and injury of angular vessels in 2 cases (5%); the last four cases were in external DCR group. Finally, there was no significant difference between groups regarding complications. • Success was reported in 35 cases (87.5%) and failure in 5 cases (12.5%); and there was non significant increase of success rate in external DCR in comparison to endoscopic DCR (90.0% vs 85.0% respectively). • No postoperative complications in 22 cases (55.0%); mild epistaxis in 3 cases (7.5%); lid ecchymosis in 4 cases (10.0%); infection in 2 cases (5.0%); scar formation in 3 cases (7.5%) (All were in external DCR group); recurrent dacryocystitis in 4 cases (10.0%) (3 of them were in endoscopic DCR group); premature tube extraction in 2 cases (5.0%) and there was no significant difference between both groups.