Abstract
SURGICAL SUCCESS AND PATIENT SATISFACTION ANALYSIS IN DOING ENDONASAL AND EXTERNAL ENDOSCOPIC DACRYOCYSTORHINOSTOMY DURING MANAGEMENT OF PRIMARY ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION

*Dr. Nada Mohammed Fahad, Dr. Muthanna Abdul Khudhur dna Dr. Ghadah Hashim Hasan

ABSTRACT

This study aimed to analyze and compare between surgical success and patient satisfaction in doing external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy for managing primary acquired nasolacrimal duct obstruction at Al-Karama Teaching Hospital in Baghdad / Iraq. In this hospital-based prospective, comparative, nonrandomized, interventional study, a total of (50) patients, 25 patients in external DCR group and 25 patients in endoscopic DCR group, diagnosed as primary nasolacrimal duct obstruction (PANDO) who were meeting inclusion criteria were enrolled during the period from 1st June 2015 to 30th May 2016 with additional 6 months and consecutive 6 months follow up for all patients. Postoperative symptomatic improvement and patency of lacrimal passage on syringing were analyzed in each follow up. The success was defined by both symptomatic improvement and patent lacrimal passage on syringing at 6 months after surgery. Intraoperative and postoperative complications were also evaluated. Patient satisfaction and quality of life were analyzed using Glasgow Benefit Inventory Questionnaire. Results showed that mean age of presentation in external DCR was 46.7±15.1 SD (range, 22-66 years) whereas in endoscopic DCR group it was 30.9 ± 10.8 SD (range, 17-49 years). Female preponderance was seen in both groups (F: M=20:5 in Ex-DCR group and 18:7 in En-DCR). Overall, success rate is 94.0% (n=47 out of 50) was demonstrated. Intergroup success rate was almost similar in both groups (Ex-DCR 24/25, 96.0% and En DCR 23/25, 92.0% with p value>0.05). The mean total score from GBI was 45.4±11.1 (95% CI, 21.2-74.0) and 63.2±17.1 (95% CI, 20.1-85.2) in Ex-DCR and En-DCR groups respectively, with P value<0.001. The mean general subscale score was 44.90±14.1(95% CI, 12.9-69.8) in Ex-DCR group and 64.9±17.2 (95% CI, 14.1-87.1) in En-DCR group with P-value<0.001. Social support subscale was 44.9±10.9 95 CI, 1-65.2) in Ex-DCR and 48.1±17.9 (95% CI, 1-75.2) in En-DCR group with p-value=0.276. Physical health subscale score was 57.1±16.1 (95% CI, 51-100) in Ex-DCR group and 73.8±19.9 (95% CI.-60-100) in En-DCR with p-value<0.001. The commonest intraoperative and post-operative complication was bleeding in both groups. It can be concluded from this study that surgical success rate is almost comparable in both groups. Endoscopic DCR was found to have better patient satisfaction compared to external DCR.

Keywords: External dacryocystorhinostomy; Endonasal dacryocystorhinostomy; success; failure; complication.


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