Endoscopic Dacryocystorhinostomy with Flap Suturing

Abstract

Multiple reports have demonstrated the efficacy of endoscopic dacryocystorhinostomy (DCR). However the results of the same have varied from centre to centre. Many still regard external DCR as the gold standard. To describe an endoscopic DCR technique which anatomically simulates an external DCR and assess its results. Prospective, nonrandomized and noncomparative interventional case series. Clinical charts of patients with nasolacrimal duct obstruction based on symptomatic, clinical and radiological basis were included in the study. All surgeries were done endonasally using standard operative technique. The modification in the standard technique included creating a wide exposure of the lacrimal sac, incising the sac and the suturing the medial wall of the lacrimal sac with the lateral nasal wall. The same was achieved by using either vascular clips or 5.0 vicryl sutures. Twenty (11 females and 9 males) were included in the study. The average age of the patients was 56.86 years old (range 27-85 years old). The main presenting symptom was epiphora and 1 patient with mucocele. Successful outcome was measured in terms of relief of sympto anatomical patency assessed by sac syringing and nasal endoscopy showing a wide patent lumen. A primary success rate of 95% and ultimate rate of 100% was achieved in the cases with a nasolacrimal duct (NLD) block while an overall success rate of 82.6% was noted when the cases with NLD block and common canalicular block were considered together. Endoscopic DCR can now easily replace external DCR as a standard. It is not only minimally invasive, but has minimal complications and using this technique, we have been able to achieve very high success rates.

Evidence-based review of surgical practices in endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction and other new indications

“…However, a statistically lower number of postoperative debridement sessions was noted [18]. Kirtane et al [19] described using 5-0 vicryl suture or vascular clips to bring the mucosal and medial lacrimal sac flaps together. The authors reported primary success in 19 of 20 EN-DCRs with nasolacrimal duct obstruction.…”

“…Kirtane et al [19] described using 5-0 vicryl suture or vascular clips to bring the mucosal and medial lacrimal sac flaps together. Kirtane [19] also noted that his outcomes with vascular clips were similar to those for sutures, with the advantage of being easier to use. The 20th case was ultimately successful after removal of a granuloma at the surgical fistula.…”

The use of an ostial stent does not increase the success rate of endoscopic dacryocystorhinostomy

“…sutured mucosal and medial lacrimal sac flaps together, with size 5-0 vicryl sutures, to prevent restenosis. They reported primary success in 19 of 20 patients with nasolacrimal duct obstructions 18 …”

Intraoperative prevention of dacryocystitis relapse

“…Kirtane и соавт. [54] предложили использовать технику эндоназальной эндоскопической ДЦР, включающую создание лоскута слизистой оболочки полости носа с основанием кзади, выкраивание аналогичного лоскута из медиальной стенки слезного мешка и затем их фиксацию двумя швами.…”