Publication:

A comparative study of complete removal of medial wall of lacrimal sac against mucosal flap technique in endoscopic endonasal dacryocystorhinostomy

Background Dacryocystorhinostomy (DCR) is the standard surgical treatment for nasolacrimal duct obstruction (NLDO), creating a fistulous tract between the lacrimal sac and the nasal cavity to relieve epiphora. While considerable literature exists comparing external DCR with endoscopic endonasal DCR, there are few comparative studies evaluating the outcomes of endoscopic endonasal DCR with mucosal flap preservation versus complete removal of the medial wall of the lacrimal sac.

Methods This was a single-center, prospective, comparative study conducted at the Department of ENT, BJMC and Sassoon Hospital, Pune, Maharashtra, India, from June 2019 to December 2020. Fifty patients with nasolacrimal duct obstruction were allocated into two groups of 25 each: Group A (complete removal of medial wall of lacrimal sac) and Group B (mucosal flap technique). Lacrimal system patency was assessed at three and six months postoperatively using the sac syringing technique.

Results Surgical success at six months was 100% in Group B versus 92% in Group A, though this difference was not statistically significant (p=0.490). There was no significant difference in postoperative pain scores between the groups (p=0.810). Ostium size shrinkage was 21.3% in Group A and 15.8% in Group B (p=0.157). Early and late postoperative complications, including granulation tissue formation and synechiae, were relatively higher in Group A.

Conclusions Mucosal flap technique and complete excision of the medial wall of the lacrimal sac in endoscopic endonasal DCR demonstrate comparable outcomes. Although statistically insignificant, the mucosal flap technique showed lower complication rates and less ostium shrinkage.