ABSTRACT
Introduction@#Dacryocystorhinostomy (DCR) is a surgical treatment for site of obstruction in the nasolacrimal duct system. This surgery is performed in cases of congenital nasolacrimal obstruction, partial and complete occlusion of the nasolacrimal duct in adults, chronic tearing disorders, ineffective probing treatment and placement of a silicone tube in the nasolacrimal system. the present findings indicate that preservation of lacrimal sac flaps with end-to-end anastomosis to the nasal mucosa using histoacryl has a positive impact on surgical outcome in patients undergoing endonasal endoscopic dacryocystorhinostomy. Histoacryl glue is one of the most commonly surgical materials used recently. The basis of our study is the lack of research on the use of this glue in the practice of oculoplastic and reconstructive surgery.@*Purpose@#To report the use of fibrin glue as an adjunctive procedure in endoscopic dacryocystorhinostomy (En-DCR) surgery and compare it to silicone tubing@*Material and Method@#Patients with primary nasolacrimal duct obstruction were retrospectively reviewed for endo-DCR between January 2017 and December 2019. Group I patients applied fibrin glue and Group II used silicone tube insertion. The fibrin glue group received end-to-end anastomosis of the nasal mucosa and lacrimal sac using fibrin glue at the end of surgery. The demographics, recurrence, causes of failure, formation of scars, final ostium size and the success rate were compared. This study was approved by the Institutional Review Board of the Chang Gung Memorial Hospital Clinical Research Ethnics Committee and followed the Declaration of Helsinki. All statistical analysis was performed with SPSS version 24.0 software (SPSS Inc., Chicago, IL, USA), and a P value < .05 was considered statistically significant. Continuous variables were presented as mean ± standard deviation, while categorical data was represented as numbers and percentages. Independent t-tests were used to compare the differences in parametric variables. The Mann-Whitney U test was performed to compare the follow-up period. Pearson’s chi-squared and Fisher’s exact tests were used to compare categorical variables. Multivariate logistic regression was used to identify the risk factors associated with recurrence. @*Result@#The age of the whole cases was between 17 and 82 years. There was no significant difference among the age groups. In terms of gender, n=48 (78.7%) were female and n=13 (21.3%) were male, indicating that dacryocystitis was predominant in women. Study reports no significant difference in intraoperative and postoperative complication. The surgical success rate was significantly higher in histoacryl group 94.9%, than silicone tube group 79.5%. Recurrent cases n=2 (5.1%) in group 1 and n=9 (20.4%) in group 2 respectively.@*Conclusion@#Fibrin glue improves the surgical outcome in patients undergoing Endo-DCR compared to commonly used silicone stenting by securing flaps apposition and maintaining the ostium opening.
ABSTRACT
Background@#Dacryocystorhinostomy (DCR) is a surgical treatment for site of obstruction in the nasolacrimal duct system [1]. This surgery is performed in cases of congenital nasolacrimal obstruction, partial and complete occlusion of the nasolacrimal duct in adults, chronic tearing disorders, ineffective probing treatment and placement of a silicone tube in the nasolacrimal system [2,3]. the present findings indicate that preservation of lacrimal sac flaps with end-to-end anastomosis to the nasal mucosa using histoacryl has a positive impact on surgical outcome in patients undergoing endonasal endoscopic dacryocystorhinostomy [4]. Histoacryl glue is one of the most commonly surgical materials used recently. The basis of our study is the lack of research on the use of this glue in the practice of oculoplastic and reconstructive surgery.@*Purpose@#The purpose of this study to comparing outcomes of surgical methods of histoacryl glue and silicone tube during endoscopic endonasal dacryocystorhinostomy.@*Methods@#Retrospective, case series study. The study included 83 patients who underwent endonasal endoscopic dacryocystorhinostomy between January 2017 to June 2020. Whole case was divided into two groups. In group 1, an anastomosis was made during surgery by using histoacryl glue to the posterior wall of the lacrimal sac and the wall formed by the nasal mucosa [5]. In group 2, a silicone tube was placed in the nasolacrimal duct during endonasal dacryocystorhinostomy and the results were evaluated in the 1st, 3rd, 6th, and 12th months after surgery. Statistical calculations were performed using SPSS software.@*Results@#The age of the whole cases was between 17 and 82 years. There were no significant difference among the age groups. In terms of gender, n=48 (78.7%) were female and n=13 (21.3%) were male, indicating that dacryocystitis was predominant in women. Study reports no significant difference in intraoperative and postoperative complication. The surgical success rate was significantly higher in histoacryl group 94.9%, than silicone tube group 79.5%. Recurrent cases n=2 (5.1%) in group 1 and n=9 (20.4%) in group 2 respectively. @*Conclusion@#Histoacryl glue is highly effective, commodity, inexpensive and easy to apply during endonasal endoscopic dacryocystorhinostomy surgery.