About endonasal laser dacryocystorhinostomy unfavorable outcomes

Abstract

Dacryocystorhinostomy (DCRS) performed with a variety of surgical approaches is the most common surgical procedure aimed at restoring the tear outflow. However, regardless of the chosen method, surgery sometimes provides only temporary effect and requires re-intervention (revision). This article presents the analysis of clinical observation of a case series including 76 patients with lacrimal outflow impairment who, in 2014-2015, underwent endonasal endoscopic laser DCRS at the Otorhinolaryngology Department of the First Pavlov State Medical University of St. Petersburg. Among these, re-operation to restore the lacrimal passage was required necessary in 19.7% of cases. The authors concluded that the most frequent reasons of DCRS insufficiency are intractable individual anatomical features of nasal structures and/or lacrimal apparatus of the patients (including atypical anatomy of the lacrimal sac and nasolacrimal duct) and high regeneration ability of the nasal cavity mucous membrane. The probability of re-stenosis increases with previously performed DCRS with unstable result in the patient’s history, concomitant somatic general diseases (diabetes, arterial hypertension, etc.). These reasons may be successfully overcome when choosing an endoscopic approach with laser technology.