“Better Handshake Together”: 3 years in interdisciplinary approach of endoscopic dacryocystorhinostomy

Abstract

Abstract Background Dacryocystorhinostomy (DCR) alleviates epiphora by fistulizing the lacrimal sac into the nasal cavity, effectively bypassing nasolacrimal duct obstruction (NLDO). Conventionally performed via an external approach, it is increasingly performed via endonasal route. With a few technical nuances, endoscopic dacryocystorhinostomy (EDCR) can now match the previous gold standard of external approach. Seamless interdisciplinary cooperation between rhinology and oculoplastic teams can be one vital step towards even better surgical outcomes. Objectives We aimed to report our experience on the surgical outcome of EDCR via perioperative cooperation between rhinology and oculoplastic teams in our centre. Secondly, we aimed to determine the association of contributing factors with functional and anatomical failure. Methods All EDCR performed as combined operation by the rhinology team and the oculoplastic team at a tertiary centre from 2017 to 2019, with a minimum postoperative follow-up of 1 month, were reviewed for their outcomes at 1 month, 3 months, 6 months, and 1 year postoperatively. Additionally, we analysed the contributing factors impacting anatomical and functional failure with SPSS version 29 via chi-square test. Results Surgical success was defined as the complete resolution of epiphora in the presence of anatomical patency of the lacrimal system, proven by endoscopic visualization or the syringing test. Our findings revealed a surgical success rate of 84.5% at both 1-month and 3-month follow-up, 82.4% at 6-month follow-up, and 76.0% at 1-year follow-up. At the 6-month follow-up, the anatomical failure rate was 6%, and all required revision surgery, whereas the rate of functional failure stood at 12%. Significant factors influencing anatomical failure were postsurgical granulation tissue/synechiae, while allergic rhinitis was statistically significant for functional failure. Age over 60, chronic rhinosinusitis, history of dacryocystitis, and diabetes mellitus were not determinants for either failure type. Conclusion The collaboration between oculoplastic and rhinology teams in endoscopic dacryocystorhinostomy for NLDO has led to favourable results. EDCR’s benefits are not constrained by old age, and a history of dacryocystitis does not impede its efficacy. However, if the underlying allergic rhinitis is not addressed, it may result in functional failure.

Keywords

• Endoscopic dacryocystorhinostomy
• Dacryocystorhinostomy
• Epiphora