External vs. Endonasal Endoscopic Dacryocystorhinostomy: Surgical Success and Patient Satisfaction

Introduction: The aim of study was to compare and analyze surgical success and patient satisfaction in doing external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy for the management of primary acquired nasolacrimal duct obstruction at tertiary care referral hospital in Kathmandu, Nepal. Methods: Hospital based prospective, comparative, nonrandomized, interventional study. A total of 70 patients, 36 patients (36 eyes) in external DCR group and 34 patients (36 eyes) in endoscopic DCR group, diagnosed as primary nasolacrimal duct obstruction (PANDO) meeting inclusion criteria were enrolled in the study from 1st June 2015 to 30 May 2016 with additional 6 months and consecutive six months follow up were observed for all patients. Postoperative symptomatic improvement and patency of lacrimal passage on syringing were analysed 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 analysed using Glasgow Benefit Inventory Questionnaire. Statistical analysis was done using IBM SPSS 21 version software programme. The pvalue< 0.05 was considered statistically significant.
Results: Total of 72 DCR surgeries (36 in each group) were performed in 70 primary NLDO patients including 2 bilateral endoscopic DCR. Mean age of presentation in external DCR was 45.17 years ± 6.05 SD (range, 21–61 years) whereas in endoscopic DCR group was 31.28 years ± 10.54 SD (range, 15-41 years). Female preponderance was seen in both groups (F: M=27: 9 in Ex-DCR group and 28:6 in En-DCR). Overall, success rate is 95.83% (n=69 out of 72). Intergroup success rate was almost similar in both groups (Ex-DCR 35/36, 97.22% and En-DCR 34/36, 94.44% and p value=1.00). The mean total score from GBI was 46.60 ± 10.61 (95% CI, 22.22-75) and 62.89 ± 18.03 (95% CI, 22.22-91.67) in Ex-DCR and En-DCR groups respectively, p value<0.001. The mean general subscale score was 44.33 ± 13.33 (95% CI, 12.50-70.83) in Ex- DCR group and 63.77 ± 19.33(95% CI, 2.50-95.83) in En- DCR group and P-value<0.001. Social support subscale was 46.76 ± 11.14 (95% CI, 0-66.67) in Ex-DCR and 49.54 ± 18.03 (95% CI, 0-83.33) in En-DCR group and p-value=0.276. Physical health subscale score was 56.48 ± 15.57(95% CI, 50-100) in Ex-DCR group and 74.54 ± 14.95 (95% CI,-66.67-100) in En-DCR p-value<0. 001. The commonest intraoperative and post-operative complication was bleeding in both groups. However, intra-operative complication rate (En- DCR, 12 (33.33%, Ex-DCR 3 (8.33%) and p-value=0.01 and postoperative complication rate (En-DCR, 11 (30.66%), Ex- DCR 19 (52.78%) p-value=0.06.
Conclusion: Surgical success rate is almost comparable in both groups. Endoscopic DCR was found to have higher intraoperative complication but minimal post-operative complication compared to external DCR. Endoscopic DCR was found to have better patient satisfaction compared to external DCR.