The benefit of silicone stents in primary endonasal dacryocystorhinostomy: a systematic review and meta-analysis.
OBJECTIVE
To critically evaluate the evidence comparing success rates of endonasal dacryocystorhinostomy (EN-DCR) with and without silicone tubing and to thus determine whether silicone intubation is beneficial in primary EN-DCR.


METHODS
Systematic review and meta-analysis.


METHODS
A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders groups trials register using a combination of various MeSH. The date of last search was January 2016. This review was limited to randomised controlled trials (RCTs) in English language. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool. Chi-square and I2statistics were calculated to determine the presence and extent of statistical heterogeneity.


METHODS
Study selection, data extraction and risk of bias scoring were performed independently by two authors in concordance with the PRISMA statement.


RESULTS
Five RCTs (447 primary EN-DCR procedures in 426 patients) were included for analysis. Moderate interstudy statistical heterogeneity was demonstrated (Chi2= 6.18; d.f. = 4; I2= 35%). Bicanalicular silicone stents were used in 229 and not used in 218 procedures. The overall success rate of EN-DCR was 92.8% (415/447). The success rate of EN-DCR was 93.4% (214/229) with silicone tubing and 92.2% (201/218) without silicone tubing. Meta-analysis using a random-effects model showed no statistically significant difference in outcomes between the two groups (P = 0.63; RR = 0.79; 95% CI = 0.3-2.06).


CONCLUSIONS
Our review and meta-analysis did not demonstrate an additional advantage of silicone stenting. A high-quality well-powered prospective multicentre RCT is needed to further clarify on the benefit of silicone stents.
Department of Otolaryngology, The Royal Infirmary of Edinburgh, Scotland, UK.
D
D
Sarode
Department of Otolaryngology, The Royal Infirmary of Edinburgh, Scotland, UK.
D A
DA
Bari
Raigmore Hospital, Inverness, Scotland, UK.
A C
AC
Cain
Department of Otolaryngology, The Royal Infirmary of Edinburgh, Scotland, UK.
M I
MI
Syed
Department of Otolaryngology, The Royal Infirmary of Edinburgh, Scotland, UK.
A T
AT
Williams
D003608:Dacryocystorhinostomy / Q000295:instrumentation*; D006801:Humans; D007440:Intubation; D012828:Silicones; D015607:Stents; D016896:Treatment Outcome
D012828:Silicones