Outcomes of Endonasal and External Dacryocystorhinostomy

1
Outcomes of Endonasal and External
Dacryocystorhinostomy

• S Leong, P Burgess, P Karkos,
• S Hampal, M Halliwell
• North Cheshire Hospitals NHS Trust

2
Aim

• To compare success rates and complications
  following endoscopic and external
  dacryocystorhinostomy.
• Criteria - BOPSS
• Standards - NICE Guidelines 2005
• - Previous audit recommendations

3
Method

• 1. Retrospective June 2003 - Aug 2007
• case note review
• 2. Postal questionnaire
• Exclusion criteria
• - Previous NLD intubation
• - Incomplete follow-up
• - Stent in-situ

4
Results

• Patients 65 ? 24 ? 41
• External 33 (2 revisions)
• Endonasal 40 (18 revisions)
• DCR Lester-Jones tubes 3
• Age Ext 65.6 (Range 44 86 SD 10.6)
• Endo 62.0 (Range 9 92 SD 17.2)

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Indication for surgery
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Site of obstruction

• External Endonasal
• Proximal canal. 0 3
• Distal canal. 2 7
• Common canal. 3 2
• NLD 28 26
• Pump failure 0 2

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Post-operative

• Mean stent duration (wk)
• External 22.6 (Range 7- 60 SD 10.9)
• Endonasal 14.5 (Range 2 - 28 SD
  5.5)
• Mean clinic follow-up (wk)
• External 27 (Range 8 - 68 SD 15.0 )
• Endonasal 26 (Range 11- 56 SD 10.4)

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Outcomes at discharge - Overall

• Improvement
• EXT 97 (32/33) ENDO 85 (34/40)

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Outcomes at discharge - Endonasal

• Improvement
• Primary 82 (18/22) Revision 89 (16/18)

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Outcome NLD obstruction

• Improvement
• EXT 97 (27/28) ENDO 89 (23/26)

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Postal questionnaire
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Postal questionnaire

• Response rate 70 (53/76)
• Mean follow-up (months)
• External 17.8 (Range 4-36 Med 16)
• Endonasal 26.6 (Range 6-54 Med 25)

13
VAS symptom score

• NLD External 9.4 (Range 5 -10 Med 10)
• Endonasal 8.1 (Range 5 10 Med 9.5)

14
Postal questionnaire

• Improvement - NLD
• EXT 96 (23/24) ENDO 91 (10/11)

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Complications External

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Complications - Endonasal
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Conclusions

• 1. Success equal to or better than published
  standards
• 2. External DCR shows higher success rates for
  primary procedures
• 3. Endoscopic DCR associated with fewer
  complications
• 4. Protocol for follow-up and stent removal
  recommended

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Thank you