A Comparative Study of Surgical Outcome in Endoscopic Endonasal Dacrocystorhinostomy with and without Stenting

Abstract

Introduction To remove tears from people’s eyes’ – is one of the greatest challenges of lacrimal surgery. Epiphora is defined as watering eye due to inadequate drainage of normally produced tears. Dacryocystitis is the inflammation of the lacrimal drainage system which presents as acute dacryocystitis or a much commonly as chronic dacryocystitis. Other common causes of ephiphora are blepharitis, conjunctivitis, trichiasis, punctal eversion and foreign bodies. The conventional treatment for watering eyes due to Naso Lacrimal Duct (NLD) is the procedure of external dacryocystorhinostomy (DCR) which has its own limitations and disadvantages. With the introduction of high resolution endoscopes for paranasal sinuses, endoscopic endonasal DCR (EnDCR) is gaining popularity. The main advantages of the endoscopic technique are minimal morbidity, less intraoperative bleed, shorter operative time, preservation of pump function of orbicularis occuli muscle, presaccal fibers and medial canthal tendon and avoidance of cutaneous scar. In EnDCR the most common cause for failure of surgery is closure of rhinostoma and to prevent this silicone tube insertion is the most preferred method. It has also been claimed that silicone tubing would improve surgical results. But studies also indicate that silicone tubing itself results in certain problems like, foreign body sensation, increased granulation tissue leading to failure, prolapse of tube leading to injury to cornea, nasal migration of tube, fistula formation, pharyngitis and associated sinusitis & recurrent nose bleed. The present study was undertaken to compare the surgical results of endoscopic endonasal DCR with and without silicone stent. Aims & Objectives To compare the success rates of endonasal dacryocystorhinostomy and evaluate the presence of post-operative changes and their effect on the outcome of the surgery in endoscopic dacryocystorhinostomy with and without stenting. Material & Methods This Prospective randomized comparative study was carried out amongst the patients attending department of ENT and referred cases from ophthalmology department for chronic nasolacrimal duct obstruction, both as inpatients and outpatients with complaint of chronic epiphora. 50 patients divided into two groups of 25 each fulfilling inclusion and exclusion criteria were included using convenient sampling. Participants were divided into two groups of 25 each based on randomization technique. Group 1 includes patients undergoing EnDCR with stenting and Group 2 includes patients undergoing EnDCR without stenting. Patients were assessed for post-operative complications like granulations, size of the neo ostium and patency of the neo ostium were assessed on nasal endoscopy. Data was entered in MS Excel work sheet. Data was analyzed using appropriate statistical methods. Result This study had Female predominance in both the groups. No predominance for any side was observed. No major intra operative complications were observed. Duration of surgery was more in Group I which was statistically significant. Post-operative complications are seen more in group without stenting (64.0%) than in group with stenting (56%) with no statistical difference between the two groups. Granulations had no effect on the outcome of the. On subjective assessment of symptoms 92% of patients in group I and 88% of patients in group II showed improvement of symptoms post operatively. No statistical difference had been found between the results of both the groups. On objective assessment of size of the neo ostium, no statistical difference was seen between the two groups. The size of the neo ostium had no effect on the outcome of the surgery. On objective assessment of patency of the neo ostium was observed in 92% of patients in group I and 88% patients in group II with no statistical difference between the two groups. Conclusion As success rates of the surgery with stenting and without stenting are comparable and