title: Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis.
abstract: BACKGROUND
  Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system.
  
  
  OBJECTIVE
  To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications.
  
  
  METHODS
  Prospective non-randomized comparative study.
  
  
  METHODS
  Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ(2) test.
  
  
  RESULTS
  Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant (P = 0.609).
  
  
  CONCLUSIONS
  Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.
authors.affiliation: Department of Ophthalmology, Kali Pada Chowdhury Medical College, Kolkata, India.
authors.forename: Rinki
authors.initials: R
authors.lastname: Saha
authors.forename: Anuradha
authors.initials: A
authors.lastname: Sinha
authors.forename: Jyoti Prakash
authors.initials: JP
authors.lastname: Phukan
keywords: Dacryocystorhinostomy; endoscopic; external
references.citation: Br J Ophthalmol. 1997 Sep;81(9):716-7
references.pmid: 9422920
references.citation: Braz J Otorhinolaryngol. 2005 May-Jun;71(3):356-60
references.pmid: 16446941
references.citation: Laryngoscope. 1998 Dec;108(12):1861-6
references.pmid: 9851505
references.citation: Acta Otorhinolaryngol Ital. 2005 Aug;25(4):209-13
references.pmid: 16482977
references.citation: J Laryngol Otol. 1989 Jun;103(6):585-7
references.pmid: 2769026
references.citation: Am J Otolaryngol. 2006 Sep-Oct;27(5):327-9
references.pmid: 16935177
references.citation: Ophthalmology. 1986 Jan;93(1):14-9
references.pmid: 3951812
references.citation: Chin Med J (Engl). 1996 Oct;109(10):747-8
references.pmid: 9275348
references.citation: Indian J Otolaryngol Head Neck Surg. 2004 Oct;56(4):259-61
references.pmid: 23120091
references.citation: Clin Ophthalmol. 2011;5:979-89
references.pmid: 21792289
references.citation: Trans Am Ophthalmol Soc. 1910;12(Pt 2):654-8
references.pmid: 16692210
references.citation: J Korean Med Sci. 2006 Aug;21(4):719-23
references.pmid: 16891819
references.citation: Rhinology. 2009 Sep;47(3):310-315
references.pmid: 19839257
references.citation: Ophthalmology. 1995 Jul;102(7):1065-70
references.pmid: 9121754
references.citation: Otolaryngol Head Neck Surg. 2000 Oct;123(4):488-91
references.pmid: 11020191
references.citation: Adv Ophthalmic Plast Reconstr Surg. 1986;5:139-68
references.pmid: 3331897
references.citation: Ophthalmology. 2005 Aug;112(8):1463-8
references.pmid: 15953636
references.citation: Laryngoscope. 2002 Jan;112(1):69-72
references.pmid: 11802041
references.citation: J Laryngol Otol. 2004 Aug;118(8):628-32
references.pmid: 15453939