Comparison of Piezosurgery and Hammer-Chisel in Endoscopic Dacryocystorhinostomy

Endoscopic Dacryocystorhinostomy - Comparative Outcomes of Powered vs. Non - Powered Instrument Techniques in a Tertiary Care Hospital

This study compares the outcomes and complications associated with Powered and Non - Powered instrument techniques in patients undergoing Endoscopic Dacryocystorhinostomy (Endo DCR). An Observational, longitudinal study was carried out on 146 cases of Chronic Dacryocystitis who were divided into two equal groups. One group underwent Endo DCR by powered instruments (Powered group - PG) and the other group by non-powered technique (Non Powered group - NPG). Operating time was taken from incision to tucking of flaps of the lacrimal sac mucosa. Postoperative assessment was done on 7th, 30th and 180th day of surgery. Subjective assessment was based on relief from epiphora while objective on lacrimal sac syringing (LSS) and Diagnostic nasal endoscopic (DNE) findings. Both the groups were compared for the success rate and complications. Out of 146 cases operated, 6 cases were cancelled due to intraoperative bleeding. 109 Endo DCR were done on right side while 31 cases were operated on left side. The mean operating time in NPG is 48.74 min and in PG is 64.91 min with p=<0.001 which is highly significant. Postoperative success rate among PG and NPG is 88.2% and 84.7% (p=0.829) while complications for both the groups were statistically not significant (p=0.701). Non-powered technique showed significant reduction in operating time compared to powered drill for Endo DCR. No significant difference was found between the powered and the non-powered groups in terms of success rate and complications surgery, Head of the Dept, Sri Devaraj Urs Academy of Higher Education and Research Medical College azeem_hn@yahoo.co.in Vast clinical knowledge, Surgical skills, with a passion in research, great teacher, motivator for junior colleagues and students, dedicated surgeon for service to mankind.

Endoscopic dacryocystorhinostomy with and without mucosal flap-is there any difference?

BACKGROUND

The nasal mucosa is sacrificed in conventional endoscopic dacryocystorhinostomies (EDCRs). Some surgeons, however, modify the technique by elevating a mucosal flap prior to creating the osteotomy with the aim of preserving the mucosa. To our knowledge, no clear-cut benefit of a mucosal flap has been established. The aim of this study is to examine the differences in surgical techniques and success rates of EDCRs with and without mucosal flap preservation.

METHODS

We carried out a medical record review of all patients who underwent primary EDCR at the Goldschleger Eye Institute from October 2009 to October 2017. The following data were retrieved from the medical database and analyzed: patient demographics (age at diagnosis and gender), medical history, examination findings, surgical details, postoperative success, complications, and follow-up.

RESULTS

A total of 107 patients who underwent 117 EDCRs participated in the study. Fifty-one patients comprised the group without a mucosal flap and 56 patients comprised the group with mucosal flap preservation. The medical history, presenting complaints, and preoperative examination findings were similar for both groups. The surgical success rate was not significantly different between the groups (82.1% without flap vs. 86.8% with flap, P = 0.478, Chi-square).

CONCLUSION

The findings of this comparison of EDCRs with and without mucosal flap preservation in a large patient population revealed no differences in surgical success or complications rates between the two procedures and, therefore, no benefit for adding flap preservation to conventional EDCRs.