Predictors of long‐term success and failure in primary and revision endoscopic dacryocystorhinostomy

Abstract

Background Although endoscopic dacryocystorhinostomy (endo‐DCR) is a common treatment of nasolacrimal duct obstruction, little is known about the determinants of surgical success and failure. The purpose of this study was to identify patient‐ and technique‐specific factors that may influence surgical outcomes of primary and revision endo‐DCR. Methods A retrospective review was conducted of 596 patients who underwent endo‐DCR over a 30‐year period (1989‐2018). Patients’ demographics and surgical techniques were assessed. Results Among the cohort of patients (n = 478) who underwent primary endo‐DCR, 10% (n = 48) required revision surgery. Patients who failed primary DCR tended to be younger (p = 0.015) and were less likely to have chronic sinonasal inflammation on histopathology (p = 0.047) than the successful surgery group. After adjusting for patient demographics and comorbidities, the occurrence of a postoperative complication was significantly associated with primary DCR failure (odds ratio [OR], 2.2; p = 0.032). Among the cohort of patients (n = 118) who underwent revision endo‐DCR, 8.5% (n = 10) required additional revision surgery. Patients who failed revision DCR tended to be younger (p = 0.022), more likely to have had intraoperative laser usage (p = 0.031), and more likely to have had an intraoperative complication (p = 0.013) than the successful revision surgery group. Endo‐DCR failure was not associated with smoking status, middle turbinate resection, or intraoperative visualization of the internal common punctum (p > 0.05). Conclusion An understanding of factors associated with primary and revision endo‐DCR failure can help to inform preoperative counseling, intraoperative surgical technique, and postoperative care in the treatment of patients with nasolacrimal duct obstruction.

Five‐ and 10‐Year Outcomes for Primary Endoscopic Dacryocystorhinostomy: Failure Rate and Risk Factors

“…Recently, Lehmann et al have also found an association between younger age and eDCR success rates. 20 Gender was significantly associated with both 5-and 10-year success rates of eDCR in our study, similar to a recent study on eDCR 20 and in contrast to a previous study on the open approach. 13 Nomura et al also addressed possible associations with eDCR surgical failures.…”

“…Table V shows a summary of sample sizes, follow-up lengths, and success rates in leading articles. Data on long-term outcomes for eDCR were reported to a lesser extent, 13,17,19,20 and none have 10-year follow-up for DCR in general and eDCR specifically.…”

“…To the best of our knowledge, this is the first study to describe a correlation between smoking and eDCR outcomes, which stand in contrast with a recent publication. 20 Briggs et al found that smoking is a poor long-term outcome predictor in functional endoscopic sinus surgery (FESS), a technique that resembles eDCR. 25 They suggest that increased mucociliary transport times along with a pro-inflammatory state of the nasal mucosa among smokers may be the cause for the finding.…”

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

“…Finally, the use of postoperative antibiotic therapy is still questioned and there is no evidence that regular administration of oral antibiotic after surgery may improve surgical outcomes. Lehmann et al in a retrospective study on 596 cases showed that patients who failed primary END‐DCR were more likely to have postoperative complications, including infections; in addition, the occurrence of a postoperative complication was significantly associated with primary END‐DCR failure 40,41 . Since operative site infection may result in scar formation and compromise healing of a patent lacrimal system, we administer postoperative antibiotic therapy.…”

Opioid Use and Sinus Surgery

“…The authors conclude that there is no significant improvement in postoperative outcomeswith the use of drug‐eluting stents when compared to nonabsorbable packing. Lehmann et al 4 . completed a retrospective review of surgical outcomes in 596 patients who underwent endoscopic dacryocystorhinostomy (DCR) over a 30‐year period, in an attempt to identify predictors of long‐term success and failure.…”