Endonasal carbon-dioxide laser assisted dacryocystorhinostomy verses external dacryocystorhinostomy

Abstract

This is a prospective, non-randomized study to evaluate and compare the results, morbidity and surgical time for endonasal carbon-dioxide laser assisted dacryocystorhinostomy and external dacryocystorhinostomy. 70 consecutive patients of chronic dacryocystitis with nasolacrimal duct obstruction were selected for the study. 36 patients under went endonasal CO2 laser assisted dacryocystorhinostomy and 34 had external dacryocystorhinostomy. Selection of the type of operation was left to the patient's choice. All the patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Patients not willing for the external incision were selected for endonasal laser assisted dacryocystorhinostomy and others were operated via external approach. Silicone tubes were put in all the patients for three months after surgery. The final follow up was 12 months after the removal of silicone tubes. The patency of the lacrimal passage was confirmed by irrigation, and patients were questioned about their symptoms.The success rates, 12 months after removal of silicone tubes were 100% in endonasal CO2 laser assisted dacryocystorhinostomy and 88.24% in external dacryocystorhinostomy. The surgical time of endonasal laser assisted dacryocystorhinostomy was 38 minutes as compared to 62 in external dacryocystorhinostomy. Complication rate in both groups was almost equal.Thus, we came to the conclusion that Endonasal CO2 laser assisted dacryocystorhinostomy is a better surgical option to external dacryocystorhinostomy in cases of chronic dacryocystitis with nasolacrimal duct obstruction, with shorter surgical time.

Primary external dacryocystorhinostomy versus primary endonasal dacryocystorhinostomy: a review

“…Not all the various types of laser endonasal DCR have been reviewed in comparison with external DCR. The use of different lasers in endonasal DCR may lead to varying success rates 8 …”

“…The development of the operating microscope and rigid endonasal endoscope caused this procedure to gain popularity 7 . Endonasal DCR can be carried out in various ways, either with or without the help of an endoscope; and with the use of different equipment such as rongeur, drill, chisel and various types of lasers 8,9 . McDonogh and Meiring first used endoscopes in transnasal DCR in 1989 10 …”

Comparing Outcomes of the Standard Technique of Endoscopic DCR with Its Modifications: A Retrospective Analysis

“…There was no significant difference in complication rates of various techniques of our cases, and these were in line with world literature. 6,7,30,31 This is due to surgeons’ familiarity with endoscopic techniques in current days and the practice of avoiding unnecessary tissue handling.…”

A Comparision of External and Endoscopic Endonasal Dacryocystorhinostomy in Tertiary Care Hospital of Kumaon Region, Uttarakhand

“…Thus, endoscopic surgery provided a new alternative for the treatment of naso-lacrimal duct obstruction. Caldwell first described endonasal DCR in 1893 and West and Halle later modified it (9) Endonasal DCR can be carried out in various ways, either with or without the help of an endoscope; and with the use of different equipment such as rongeur, drill, chisel and various types of lasers (10,11). McDonogh and Meiring first used endoscopes in transnasal DCR in 1989 (12).…”