Endoscopic Dacryocystorhinostomy With or Without Intraoperative Application of Mitomycin C- A Comparative Study

Abstract

BACKGROUNDEndoscopic Dacryocystorhinostomy (DCR) is one of the increasingly recognised surgeries performed by an Otorhinolaryngologist in the recent years. It is the surgery of choice for post saccular lacrimal obstruction. The most common cause of failure of dacryocystorhinostomy is secondary to reclosure of stoma due to scarring, adhesion and granulation tissue formation. Several modifications have been put forward by various authors in order to shorten operative time, reduce complications and to improve overall success rate of this surgery.The aim of this study is to study the efficacy and safety of intraoperative use of Mitomycin C in endoscopic dacryocystorhinostomy. MATERIALS AND METHODSStudy Design-Randomised controlled trial. This study was conducted in Department of Otolaryngology and Head and Neck Surgery, Academy of Medical Sciences, Pariyaram, Kerala, India. A total of 30 patients who underwent Endoscopic Dacryocystorhinostomy for post saccular lacrimal obstruction during the period of 15 months from June 2014 to August 2015 were included in the study. On the basis of randomisation technique by using lottery method, patients were assigned to two groups of 15 each; the Mitomycin C (MMC) group in which we used topical Mitomycin C (0.5 mg/mL) and the Control group without using Mitomycin C. Each patient was followed up with lacrimal syringing, tear meniscus height (TMH) assessment and endoscopic inspection of DCR stoma. The complications and the surgical outcomes were compared between the two groups. RESULTSA total of 30 Endoscopic Dacryocystorhinostomy was performed. At the end of 6 months followup period, 100% of patients in MMC group were asymptomatic when compared to 86.67% patients in the control group. The complications observed in the control group were granulation at the stomal site and synechiae formation. CONCLUSIONFrom the present study, we conclude that use of intraoperative Mitomycin C application over the DCR stomal edges can be recommended as a safe and effective method of prevention of postoperative stomal stenosis. KEYWORDS

Intra-Operative Mitomycin-C as Adjuvant Therapy in External and Endonasal Dacryocystorhinostomy: Systematic Review and Meta-Analysis

“…Of the included studies, the number of patients submitted to Ex-DCR was slightly lower than that submitted to En-DCR. However, the number of subjects who received MMC in Ex-DCR (14 studies) [6,8,11,[22][23][24][25][26][27][28][29][30][31][32], as well as in En-DCR (13 studies) [4,12,21,[33][34][35][36][37][38][39][40][41][42], was similar in both techniques. The clinical heterogeneity is considered the major disadvantage of all the clinical studies.…”

“…Multiple factors such as racial variations, age, and sex of the patient can also affect the eventual outcome of the surgery. All the published RTCs about MMC effects in DCR except five [6,24,31,32,36] are from the Middle East [12,23,25,28,29] or Asia [4,8,11,21,22,26,27,30,33,34,35,37,38,39,40,41,42] inducing a possible racial component variation in the performed metanalysis.…”

“…The concentration of MMC varied from one study to another, reflecting the uncertainty over the optimal dosage required. A concentration of 0.2 mg/ml was the most used in Ex- [6, 8, 11, 22-24, 26-28, 30, 32] or En-DCR [4,12,21,34,37,39,41], with some studies using a concentration of 0.5 mg/ml in Ex [31] or in En-DCR [33,36,40,42]. The concentration of 0.4 mg/ml was applied in two studies involving En-DCR [35,38].…”