Comparison of external and endoscopic endonasal dacryocysto-rhinostomy: a hospital based retrospective study

Background: The aim of the study was to compare and analyze the surgical outcome in doing external dacryocystorhinostomy (Ex-DCR) and endoscopic endonasal dacryocystorhinostomy (En-DCR), at our tertiary care referral hospital of this hilly region of northern India. Design was retrospective and comparative.Methods: A retrospective review of total 106 patients with unilateral or bilateral primary nasolacrimal duct obstruction (NLDO), who had undergone either Ex-DCR or En-DCR surgery that included revision surgeries, with or without silicone tube intubation (STI), for a period of two years from October 2013 to September 2015, were enrolled in this study. Consecutive six months follow up was observed, in all. Surgical outcome was evaluated at each follow up, objectively and subjectively. Statistical data was analyzed using IBM SSPS 23.0 version software. P-value <0.05 was considered statistically significant.Results: Total 111 DCR surgeries (55 Ex-DCR, 56 En-DCR), were performed on 106 primary NLDO patients, including 5 bilateral En-DCR. Mean age for Ex-DCR and En-DCR was 52±17years, 36±18years, respectively. Female preponderance was seen in both the groups (F:M=41:14 in Ex-DCR, 32:14 in En-DCR). Overall, the success rate of DCR surgery was 92.80% (n=103 out of 111). Intergroup success rate was found to be almost similar (Ex-DCR 52/55; 94.54%; En-DCR 51/56; 91.07%, P=1.00), whereas, ultimate success rate considering repeat /revision surgeries following failed DCR (n=8, Ex-DCR-3,En-DCR-5) was 100%. Commonest perioperative and late complication in both the groups were, hemorrhage and rhinostomy scarring, respectively.Conclusions: Success and complication rate of both Ex-DCR and En-DCR surgeries are almost similar after primary DCR surgeries. We emphasize the advantage of doing En-DCR in bilateral NLDO, repeat/revision DCR, NLDO associated with additional intranasal disease, other than its esthetic advantage over Ex-DCR. However, further multicentric randomized controlled studies are required to substantiate our findings.