Endoscopic dacryocystorhinostomy: reasons for failure

Keren, Shay; Abergel, Avraham; Manor, A; Rosenblatt, Amir; Koenigstein, Dvir; Leibovitch, Igal; Cnaan, Ran Ben

doi:10.1038/s41433-019-0612-y

“…A statistically significant association between the identification of granuloma formation at week 6 follow-up appointment and outcome has been found in our study (p = 0.001). Previous reports have also suggested that granuloma development around the neo-ostium might be associated with failure [21,22]. These data support the role of a regular and careful follow-up and post-operative osteotomy site debridement in the management of these patients.…”

Section: Resultssupporting

confidence: 76%

Untitled

2021

J Otolaryngol Rhinol

0

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Purpose: Endoscopic dacryocystorhinostomy (en-DCR) is the mainstay of treatment of patients with nasolacrimal duct obstruction, with current success rates above 90%. Our aim was to evaluate multiple demographic and technical factors and estimate its influence on the outcome of en-DCR. Methods:We performed a retrospective review of the clinical records of patients submitted to a DCR at the Lacrimal Surgery Unit of the Centro Hospitalar Tondela-Viseu between June 2010 and December 2018, and collected data on demographic characteristics, preoperative consultation notes, surgical reports, complications and follow-up results.Results: Our study included 107 en-DCR procedures (92 consecutive patients), with an overall success rate of 89.7%. The post-operative finding of granulation tissue by post-operative week 6 was associated with a negative outcome (p = 0.001). None of the other variables studied achieved a statistically significant association with the outcome, including the presence of multiple comorbidities, performance of ancillary procedures or history of dacryocystitis; however, previous ocular surgery showed a tendency toward poorer results. Conclusion:Determining factors associated with surgical failure can help advice patients accordingly in the preoperative setting. Our study analyzed multiple variables and concluded that previous ocular surgery approached a statistically significant association with the outcome. The addition of ancillary procedures (nasal or ophthalmological) does not negatively influence the outcome of en-DCR and the presence of comorbidities should not preclude surgery.

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“…Wormald and Tsirbas demonstrated in a prospective trial that functional obstructions had lower success rates (84%) compared to anatomical obstructions (97%) [23]. Similarly to our work, other studies have compared the outcomes of functional and anatomical obstructions, but the limited number of functional diagnosis hinders drawing assertive conclusions [22]. Patients whose surgical indications were chronic or recurrent dacryocistitis showed outcomes comparable to those with epiphora only.…”

Section: Resultssupporting

confidence: 66%

“…Patients whose surgical indications were chronic or recurrent dacryocistitis showed outcomes comparable to those with epiphora only. Other papers showed similar findings regarding surgery under the indication of repeated dacryocistitis events [22,24].…”

Section: Resultssupporting

confidence: 60%

Primary Endonasal Dacryocystorhinostomy - Impact of Multiple Factors on the Outcome

Miguel¹,

Patrão²,

Márcia³

et al. 2021

J Otolaryngol Rhinol

1

0

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Purpose: Endoscopic dacryocystorhinostomy (en-DCR) is the mainstay of treatment of patients with nasolacrimal duct obstruction, with current success rates above 90%. Our aim was to evaluate multiple demographic and technical factors and estimate its influence on the outcome of en-DCR. Methods:We performed a retrospective review of the clinical records of patients submitted to a DCR at the Lacrimal Surgery Unit of the Centro Hospitalar Tondela-Viseu between June 2010 and December 2018, and collected data on demographic characteristics, preoperative consultation notes, surgical reports, complications and follow-up results.Results: Our study included 107 en-DCR procedures (92 consecutive patients), with an overall success rate of 89.7%. The post-operative finding of granulation tissue by post-operative week 6 was associated with a negative outcome (p = 0.001). None of the other variables studied achieved a statistically significant association with the outcome, including the presence of multiple comorbidities, performance of ancillary procedures or history of dacryocystitis; however, previous ocular surgery showed a tendency toward poorer results. Conclusion:Determining factors associated with surgical failure can help advice patients accordingly in the preoperative setting. Our study analyzed multiple variables and concluded that previous ocular surgery approached a statistically significant association with the outcome. The addition of ancillary procedures (nasal or ophthalmological) does not negatively influence the outcome of en-DCR and the presence of comorbidities should not preclude surgery.

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“…6 In addition, when considering EN-DCR, patients with a history of chronic rhinosinusitis (CRS) appear to be at heightened risk for POI, even in the absence of active infection at the time of surgery. 18 This concept is supported by Shams et al who reported a rate of POI for patients without a history of CRS as 1.5% following EN-DCR compared to 15% for patients with a history of CRS. 7 Additionally, published rates of acute rhinosinusitis following ESS for CRS range between 11.9 and 20.0%, despite antibiotic prophylaxis.…”

Section: Discussionmentioning

confidence: 83%

“…The management of concurrent rhinosinusitis and avoidance of scar tissue formation at the neo-ostium appear to be essential in mitigating long-term sequelae and optimizing results. 16–18 A previous study of patients who underwent primary EN-DCR at our institution found that 10% ultimately require a revision procedure. 5 Furthermore, a postoperative complication, such as POI, was found to be a major predictive factor for revision (OR: 2.2).…”

Section: Discussionmentioning

confidence: 98%

Infection After Endoscopic Dacryocystorhinostomy: Incidence and Implications

Jafari

¹

,

Lehmann

²

,

Shen

³

et al. 2020

Am J Rhinol�Allergy

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Background Endoscopic dacryocystorhinostomy (EN-DCR) is an increasingly common procedure performed by otolaryngologists. While EN-DCR has a high rate of success at relieving blockage of the lacrimal system, little is known regarding associated postoperative infection (POI) rates and risk factors. Objective The purpose of this study was to identify factors associated with the occurrence of postoperative orbital and rhinologic infection in a large cohort of patients undergoing EN-DCR. Methods A retrospective review of 582 patients who underwent EN-DCR was performed. All patients received antibiotic prophylaxis as a single intraoperative intravenous administration and a ten-day postoperative oral course. Clinical and demographic information was reviewed, including the occurrence of acute orbital or rhinologic infection within 30 days of surgery. Multivariable analysis was performed to identify risk factors associated with POI. Results Fifteen of 582 patients (2.6%) developed POI following EN-DCR. The most common POI was acute rhinosinusitis (10/15, 66.7%), followed by acute dacryocystitis (2/15, 13.3%), preseptal cellulitis (2/15,13.3%), and acute bacterial conjunctivitis (1/15, 6.7%). The majority of patients (464/582, 79.7%) underwent concurrent endoscopic sinus surgery (ESS). In most cases (302/464, 65.1%), ESS was performed to address comorbid rhinosinusitis, whereas 7.8% (36/464) of patients underwent surgery to enhance surgical access to the lacrimal sac. Patients who underwent concurrent ESS were less likely to develop POI (OR: 0.17, CI: 0.04-0.80, p < 0.05). Evidence of mucopurulence at surgery increased the likelihood of POI (OR: 6.24, CI: 1.51-25.84, p < 0.05). Conclusion Mucopurulence at the time of surgery significantly increased the risk of POI, whereas concurrent ESS, performed most commonly to address comorbid rhinosinusitis, significantly decreased the risk of POI. Awareness of risk factors for POI and appropriate surgical management of concurrent rhinosinusitis can lead to reduced infectious complications after EN-DCR.

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Endoscopic dacryocystorhinostomy: reasons for failure

Cited by 28 publications

References 17 publications

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Primary Endonasal Dacryocystorhinostomy - Impact of Multiple Factors on the Outcome

Infection After Endoscopic Dacryocystorhinostomy: Incidence and Implications

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