title: External dacryocystorhinostomy in consultants and fellows - a comparison of the causes of failure.
abstract: OBJECTIVE
  Failure of primary dacryocystorhinostomy (DCR) often requires revision surgery to inspect the cause of failure and re-establish anatomic patency. This study aims to specifcally compare the anatomical causes of failure noted during revision DCR of primary external DCR (EX-DCR) and compare the difference between consultants and fellows.
  
  
  METHODS
  A retrospective review of 37 patients who underwent revision of a primary external approach DCR over a 7-year-period in a University Hospital. All primary surgery was performed by either a consultant surgeon or senior oculoplastic fellow. Details of the initial pathology prior to primary DCR and grade of operating surgeon were collected along with perioperative surgical findings. The cause of failure of the initial surgery was classified according to perioperative findings. Failure was classified as either inappropriately sized/located ostium or fibrous/membranous soft tissue obstruction of the newly created ostium.
  
  
  RESULTS
  The cause of failure of the initial surgery was soft tissue obstruction in 43.3% and an inappropriately sized/located ostium in 56.7%. In those patients whose primary surgery was performed by a consultant, 73.3% were found to have a soft tissue obstruction and 26.7% were found to have an inappropriately sized/ located ostium. In contrast, if initial surgery was performed by a fellow, 22.7% were found to have a soft tissue obstruction and 77.3% an inappropriately sized/ located ostium (p =0.002).
  
  
  CONCLUSIONS
  Where the primary surgeon has been a trainee there is a trend toward inadequately sized or located ostium being the most likely causative factor in failure of primary EX-DCR.  Hippokratia 2015; 19 (3): 216-218.
authors.affiliation: Ophthalmology Department, St James University Hospital, Beckett Street, Leeds, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Sullivan
authors.affiliation: Ophthalmology Department, St James University Hospital, Beckett Street, Leeds, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Fearnley
authors.affiliation: Ophthalmology Department, St James University Hospital, Beckett Street, Leeds, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Al-Maskari
authors.affiliation: Ophthalmology Department, St James University Hospital, Beckett Street, Leeds, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: El-Hindy
authors.affiliation: Ophthalmology Department, St James University Hospital, Beckett Street, Leeds, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Kalantzis
authors.affiliation: Ophthalmology Department, St James University Hospital, Beckett Street, Leeds, United Kingdom.
authors.forename: B Y
authors.initials: BY
authors.lastname: Chang
keywords: External dacryocystorhinostomy; causes of failure; consultant; fellow; revision surgery