A Systematic Review of Benefit of Silicone Intubation in Endoscopic Dacryocystorhinostomy

Abstract

ObjectivesInsertion of a silicone stent during endoscopic dacryocystorhinostomy (DCR) is the most common procedure to prevent rhinostomy closure. It has been claimed that silicone intubation improves the surgical outcomes of endoscopic DCR. However, many reports have documented an equally high success rate for surgery without silicone intubation. Accordingly, we conducted a systematic review and meta-analysis to clarify the outcomes of endoscopic DCR with and without silicone intubation and determine whether silicone intubation is actually beneficial for patients.MethodsPubMed, Embase, and Cochrane Library databases were searched to identify relevant controlled trials evaluating endoscopic DCR with and without silicone intubation. The search was restricted to English articles published between January 2007 and December 2016. Relevant articles were reviewed to obtain information pertaining to interventions and outcomes. We also performed a meta-analysis of the relevant literature.ResultsIn total, 1,216 patients included in 12 randomized controlled trials were pooled. A total of 1,239 endoscopic DCR procedures were performed, and silicone stents were used in 533 procedures. The overall success rate for endoscopic DCR was 91.9% (1,139/1,239), while the success rates with and without silicone intubation were 92.9% (495/533) and 91.2% (644/706), respectively. There was no statistically significant heterogeneity among the included studies. A meta-analysis using a fixed-effects models showed no significant difference in the success rate between endoscopic DCR with silicone intubation and that without silicone intubation (OR, 1.38; 95% CI, 0.89 to 2.12; P=0.148; z=1.45). Furthermore, there were no significant differences with regard to surgical complications such as synechia, granulation, and postoperative bleeding.ConclusionThe findings of our meta-analysis suggest that the success rate and postoperative complication rate for endoscopic DCR is not influenced by the use of silicone intubation during the procedure.

Impact of Post-Surgical Therapies on Endoscopic and External Dacryocystorhinostomy: Systematic Review and Meta-Analysis

“…65,66 In general, even with such colonisation, silicone stenting paradoxically seems to increase success rates in both END-DCR, with no significant difference compared to the control group and EXT-DCR. 63,[67][68][69][70] However, as suggested by Murphy et al, if lacrimal stents are left in place for long periods, the resulting biofilms can interfere with the post-operative healing process and final success rates. 71 Given the potential influence of granulation tissue on the neo-rhinostomy, both with and without the application of silicone stents, even if it has not been demonstrated that ocular steroid application is useful in achieving higher success rates after END-DCR or EXT-DCT, steroid eye drops are generally considered the mainstay of post-operative treatment since they act as an antiinflammatory agent and prevent early closure of the neo-rhinostomy.…”

“…Its application is a controversial topic in the literature since some authors have reported its benefit in delaying fibrous closure and maintaining the patency of the neo-rhinostomy, while others report that the device predisposes to tissue granulation, adhesions and infections. 63,64 In fact, silicone tubes, by acting as a foreign body, can cause local inflammation and microorganism colonisation, which has been reported to be present in 94.7% of EXT-DCR and END-DCR, but is not sufficient to cause a clinical infection. 65,66 In general, even with such colonisation, silicone stenting paradoxically seems to increase success rates in both END-DCR, with no significant difference compared to the control group and EXT-DCR.…”

“…65,66 In general, even with such colonisation, silicone stenting paradoxically seems to increase success rates in both END-DCR, with no significant difference compared to the control group and EXT-DCR. 63,67–70 However, as suggested by Murphy et al., if lacrimal stents are left in place for long periods, the resulting biofilms can interfere with the post-operative healing process and final success rates. 71…”

A case of endonasal balloon‐assisted dacryoplasty after failure of endonasal dacryocystorhinostomy

“…Several authors sustain that silicone tubing may improve surgical outcomes by maintaining the patency of the lacrimal system 27,28 . At the same time, multiple systematic reviews and meta‐analyses have not demonstrated any additional advantages in silicone device placement, especially in endoscopic procedures 29,30 . A silicone stent may act as foreign inorganic material, leading to granulation with subsequent closure of the rhinostomy 31 .…”

Adjunctive techniques to dacryocystorhinostomy: an evidence‐based review with recommendations

“…Three additional meta-analyses have since been published; 2 in 2018 by Kang et al 45 and Kim et al 46 with a third published in 2020 by Orsolini et al 47 All 3 studies included the same 9 RCTs, [48][49][50][51][52][53][54][55][56] while Kang et al 45 and Orsolini et al 47 both also included 2 additional RCTs. 57,58 Both of the studies, by Kim et al 46 (odds ratio [OR] 1.45; 95% CI, 0.77 to 2.73) and Kang et al 45 (OR 1.38; 95% CI, 0.89 to 2.12), concluded that there was no statistically significant difference in success rates. The Orsolini et al 47 study found that stent use favored greater success rates (OR 1.62; 95% CI, 1.01 to 2.59); however, given the wide CI and closeness to the null line (1.01), the recommendation for stent usage was weak overall.…”