Endoscopic endonasal balloon-dacryoplasty in failed dacryocystorhinostomy

Abstract

Objective: Endoscopic endonasal balloon-assisted dacryoplasty is a minimally-invasive surgical procedure that can be used in recurrent epiphora, a common pathology in both adulthood and childhood. Study design/Settings: We present a retrospective case series of eight patients who underwent trans-nasal balloon-assisted dacryoplasty after a failed external or endoscopic dacryocystorhinostomy, from March 2019 to January 2020, at the Department of Otolaryngology, San Raffaele Hospital, Milan, Italy. Subjects and Methods: All patients underwent routine preoperative work-up including fluorescein test (Jones test I–II), probing and irrigation of the lacrimal pathway and nasal endoscopy. Because of the recurrent nature of the pathology, pre-operatory computed tomography scan or dacryocystography was not performed. The surgical procedure was based on enlargement of the stenotic neorhinostomy created by primary dacryocystorhinostomy through the use of a high-pressure balloon catheter. Anatomical success was defined as a patent ostium on irrigation, whereas functional success was defined as free lacrimal flow on functional test and resolution of epiphora. Results: Anatomic and functional success was achieved in 100% of patients. Operative time ranged from 9 to 22 min (mean 16 min). No significant complications were reported. Conclusion: Our results indicate that trans-nasal balloon-assisted dacryoplasty can be considered as a safe and reliable surgical approach after a failed primary dacryocystorhinostomy. The shorter surgical time and reduced post-operative complication rates are the main advantages of this procedure.

Multidisciplinary approach to lacrimal system diseases

“…If a secondary re-stenosis of the neo-rhinostomy occurs, END-DCR seem to be the treatment of choice since it provides direct visualization of intranasal abnormalities which cause surgical failure, with no superiority demonstrated over EXT-DCR 28 . In addition to this, a new endoscopic approach has been proposed, based on endonasal balloon dilatation of the stenotic neorhinostomy, with encouraging data 29,30 (Fig. 3).…”

Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies

“…Our results demonstrate that, after mean follow-up of 19.5 months and no adverse events, balloon-END-DCP provides reliable and stable outcomes with anatomical success of 100% and functional success of 85.7%, which is slightly decreased compared to our preliminary results at 6.4 months [ 19 ]. In fact, as demonstrated by Allon et al, a mean follow-up of 18 months is required to define the result as being stable for revision surgeries, since late neorhinostomy closure can occur [ 34 ].…”

“…Conversely, another revision END-DCR case-series made by Allon et al [ 17 ] presented lower success, with yearly rates, from immediate to 5 years, of 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9%, respectively. Even if dichotomous compared to the work of Ali et al, the difference noted with the latter study can be explained by the less invasiveness and bone exposure of balloon END-DCP compared to standard END-DCR, which is also demonstrated by the reduced surgical time and the possibility to perform the balloon-END-DCP in local anesthesia [ 19 ]. Another reason for the lower surgical successes of Allon et al can be explained by the long follow-up period and larger cohort size.…”

“…However, even if no significant difference has been noted, over the past few years, the END-DCR has gained popularity among clinicians for revision surgeries because, using endoscopic instrumentation, it provides a direct identification of the cause for the surgical failure and permits its rectification [ 18 ]. In addition, several endoscopic mini-invasive approaches have been proposed, with particular attention to balloon-assisted endoscopic dacryoplasty (balloon END-DCP), which is a high-pressure balloon catheter system introduced through the nose and used to restore the lacrimal pathway in revision cases of distal acquired obstruction [ 19 ]. In fact, although a trans-canalicular balloon-assisted approach has been previously described, its potential damage to the canalicular system has limited its application in favor of endoscopic approaches [ 20 ].…”

The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases

“…Such features improve the possibility to resolve the specific cause of DCR failure and treat concurrent pathologies, which an external approach may not provide; as a consequence, END-DCR should be preferred in case of recurrent distal lacrimal obstruction. 29,30 Following this evidence, among the failed procedures of our cohort who accepted revision surgery, all were treated with an endoscopic approach with an overall success rate of 90.6% at last follow-up.…”