Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ±â€¯11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

Factores implicados en el éxito y fracaso de la dacriocistorrinostomía endoscópica desde nuestra experiencia / Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience

Introducción: La dacriocistitis crónica es la patología secundaria a la estenosis del conducto lacrimonasal (ECLN) permanente, generando epífora y conjuntivitis de repetición. La dacriocistorrinostomía endoscópica (DCRE) supone una vía más natural que la vía externa y ofrece tasas de éxito superiores a la técnica láser. Valoramos la experiencia de este centro en este procedimiento. Pacientes y métodos: Se efectuó una revisión retrospectiva de los registros médicos en pacientes adultos sometidos a DCRE por ECLN entre 1995 y 2019 en nuestro centro. El período de seguimiento mínimo requerido después de la cirugía fue de seis meses. Resultados: En 297 meses se efectuaron 167 procedimientos de DCRE sobre 156 pacientes, con una edad media de 65,7±11,6 años y una relación hombre/mujer de 1/1,98. La mejoría funcional fue del 86%, con una tasa de éxito anatómico del 87%. La ausencia de mejoría clínica se correlacionó de forma estadísticamente significativa con la edad del paciente y el tiempo de evolución de la ECLN, la presencia de patología concomitante sistémica (especialmente diabetes mellitus) u oftalmológica, el hallazgo intraoperatorio de un saco lacrimal engrosado y la ausencia de drenaje del mismo al marsupializarlo. Los pacientes con peor respuesta fueron portadores de stents en la rinostomía durante más tiempo. No existieron complicaciones postoperatorias de interés. Conclusiones: La DCRE es una técnica eficaz y segura, fundamentada en referencias anatómicas estables. La incidencia de fracasos parece multifactorial y debe contemplarse en pacientes añosos, pluripatológicos y con largo tiempo de evolución de la enfermedad. (AU)

Introduction: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. Patients and methods: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. Results: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7±11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. Conclusions: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition. (AU)

Nose sinus manometry in evaluating functional outcomes of anterior and posterior endoscopic dacryocystorhinostomy.

OBJECTIVE: The aim of this study is to evaluate the effectiveness of anterior and posterior dacryorhinocystostomy (En-Dcr) by assessing the surgical outcome with a new objective technique, nose sinus manometry. MATERIALS AND METHODS: Thirty adult patients presenting nasolacrimal duct obstruction were enrolled in this study and randomly divided in two groups. In group A patients underwent anterior endonasal dacryorhinocystostomy, group B underwent the posterior approach. All patients were evaluated through Nose Sinus Manometry, endoscopic dye disappearance functional test (EDFT) and subjective assessment three months post-op. Pearson test and T-student Test were used for evaluations. RESULTS: The mean differences in the pressure values were significantly different in the two groups of treatment, therefore, the patients of group B had strong improvement in pressure values compared with patients of group A. CONCLUSION: This study confirms a relevant physical distinction between posterior En-Dcr outcomes compared to anterior En-Dcr and reveals a significant success rate difference between the two groups of patients. The posterior surgical technique shows better results than the anterior one, by providing an almost physiological post- operative endonasal outcome. These results also showed the effectiveness of Nose Sinus Manometry in assessing the post- operative outcomes after En-Dcr.

Nose sinus manometry in evaluating functional outcomes of anterior and posterior endoscopic dacryocystorhinostomy

Objective: The aim of this study is to evaluate the effectiveness of anterior and posterior dacryorhinocystostomy (En-Dcr) by assessing the surgical outcome with a new objective technique, nose sinus manometry.Materials and methodsThirty adult patients presenting nasolacrimal duct obstruction were enrolled in this study and randomly divided in two groups. In group A patients underwent anterior endonasal dacryorhinocystostomy, group B underwent the posterior approach. All patients were evaluated through Nose Sinus Manometry, endoscopic dye disappearance functional test (EDFT) and subjective assessment three months post-op. Pearson test and T-student Test were used for evaluations.ResultsThe mean differences in the pressure values were significantly different in the two groups of treatment, therefore, the patients of group B had strong improvement in pressure values compared with patients of group A.ConclusionThis study confirms a relevant physical distinction between posterior En-Dcr outcomes compared to anterior En-Dcr and reveals a significant success rate difference between the two groups of patients. The posterior surgical technique shows better results than the anterior one, by providing an almost physiological post- operative endonasal outcome. These results also showed the effectiveness of Nose Sinus Manometry in assessing the post- operative outcomes after En-Dcr. (AU)

Antecedentes y objetivo: El objetivo de este estudio es evaluar la efectividad de la dacriocistorrinostomía anterior y posterior (En-Dcr) mediante la evaluación del resultado quirúrgico con una nueva técnica objetiva, la manometría del seno nasal.Materiales y métodosTreinta pacientes adultos que presentaban obstrucción del conducto nasolagrimal se inscribieron en este estudio y se dividieron al azar en dos grupos. En el grupo A, los pacientes se sometieron a dacriocistorrinostomía endonasal anterior, en el grupo B se sometió al abordaje posterior. Todos los pacientes fueron evaluados mediante manometría de seno nasal, prueba EDFT y evaluación subjetiva tres meses después de la operación. Análisis estadístico utilizado: la prueba de Pearson y la prueba t Student se utilizaron para las evaluaciones.ResultadosLas diferencias medias en los valores de presión fueron significativamente diferentes en los dos grupos de tratamiento, por lo tanto, los pacientes del grupo B tienen una fuerte mejora en los valores de presión en comparación con los pacientes del grupo A.ConclusionesEste estudio confirma una distinción física relevante entre los resultados posteriores de En-Dcr, en comparación con los anteriores En-Dcr, y revela una diferencia significativa en la tasa de éxito entre los dos grupos de pacientes. La técnica quirúrgica posterior muestra mejores resultados que la anterior, al proporcionar un resultado endonasal postoperatorio casi fisiológico. Estos resultados también mostraron la efectividad de la manometría de seno nasal para evaluar los resultados postoperatorios después de En-Dcr. (AU)

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience. / Factores implicados en el éxito y fracaso de la dacriocistorrinostomía endoscópica desde nuestra experiencia.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ± 11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

Evaluación de los resultados de la dacriocistorrinostomía endoscópica potenciada / Powered endoscopic dacrocystorhinostomy

La epífora producida por obstrucción del conductor nasolagrimal ha sido tratada tradicionalmente con una dacriocistorrinostomía externa (DCR). La DCR endonasal puede ofrecer asimismo una tasa elevada de permeabilidad prolongada del conducto sin requerir una incisión nasal externa y sin interrupción del ligamento de canto medial y el efecto posterior que esto puede tener sobre el mecanismo de bomba lagrimal. Esta revisión describe la técnica de la DCR endonasal de alta potencia y resume los resultados logrados con esta técnica.

Epiphora caused by obstruction of the nasolacrimal ducthas traditionally been treated with an external dacrocystorhinostomy (DCR). Endonasal DCR can offersimilarly high rate of long term duct patency without requiring an external nasal incision and without the disruption of the medial canthal ligament and subsequent effect that this may have on the lacrimal pump mechanism. This review describes the technique of powered endonasal DCR and summarises the results achieved with this technique.