Gupta Nishi, Arora Rubeena, Goyal Aashish
Dr. Shroff's Charity Eye Hospital, Delhi, India.
Civil Hospital, Panchkula, India.
Eur Arch Otorhinolaryngol. 2025 Jan;282(1):287-291. doi: 10.1007/s00405-024-09043-8. Epub 2024 Oct 22.
Endoscopic dacryocystorhinostomy is a well-established procedure with high success rate. There are multiple causes of failure of this procedure which affect surgical success.
To analyze causes of failure in endoscopic dacryocystorhinostomy and ascertain methods to overcome causes of failure.
After approval from the Institutional Review Board a retrospective review of 119 patients was undertaken over an 11-year period from 2008 to 2018.
A tertiary care hospital in North India.
Patients presenting to the Otorhinolaryngology out-patient department and diagnosed as failed endoscopic dacryocystorhinostomy cases.
After thorough preoperative workup consisting of history, examination and diagnostic nasal endoscopy, patients underwent revision endoscopic dacryocystorhinostomy.
After exclusion of 2 cases, 117 patients were included in the study. The mean age at presentation was 31.4 years. Number of previous surgeries: 92 patients had had one surgery, 20 patients had had two surgeries, 5 patients had had three surgeries and 9 patients had had multiple surgeries before presentation. All patients (100%) had epiphora, 75 (64.1%) patients had associated discharge and 4 (3.4%) had persistent medial canthal swelling. Duration of symptoms following previous surgery was 1-6 weeks. Commonest cause of failure was incomplete sac exposure in 117/117 cases (100%). Other causes were cicatricial closure of ostium in 47 (40.1%), synechiae in 20 (17%), canalicular obstruction in 4(3.4%), lacrimal sac diverticulum in 3 (2.5%), nasal polyps in 2 (1.7%), concha with adhesion in 2 (1.7%), septal deviation in 2 (1.7%) cases.
Meticulous and thorough sac exposure is the most important factor affecting surgical success. Comprehensive preoperative assessment of cases, meticulous surgical technique, and postoperative follow up are needed for successful outcomes.
内镜下泪囊鼻腔造口术是一种成熟的手术，成功率很高。该手术失败有多种原因，会影响手术成功。
分析内镜下泪囊鼻腔造口术失败的原因，并确定克服失败原因的方法。
经机构审查委员会批准，对2008年至2018年11年间的119例患者进行回顾性研究。
印度北部的一家三级护理医院。
到耳鼻咽喉科门诊就诊并被诊断为内镜下泪囊鼻腔造口术失败的患者。
在进行包括病史、检查和诊断性鼻内镜检查在内的全面术前检查后，患者接受了内镜下泪囊鼻腔造口术翻修手术。
排除2例后，117例患者纳入研究。就诊时的平均年龄为31.4岁。既往手术次数：92例患者曾接受过一次手术，20例患者曾接受过两次手术，5例患者曾接受过三次手术，9例患者在就诊前接受过多次手术。所有患者（100%）有溢泪，75例（64.1%）患者伴有分泌物，4例（3.4%）有内眦持续肿胀。既往手术后症状持续时间为1 - 6周。最常见的失败原因是117/117例（100%）泪囊暴露不充分。其他原因包括造口瘢痕性闭合47例（40.1%）、粘连20例（17%）、泪小管阻塞4例（3.4%）、泪囊憩室3例（2.5%）、鼻息肉2例（1.7%）、鼻甲粘连2例（1.7%）、鼻中隔偏曲2例（1.7%）。
细致彻底的泪囊暴露是影响手术成功的最重要因素。成功的结果需要对病例进行全面的术前评估、细致的手术技术和术后随访。
