Comparison of surgical outcome between anterior-posterior flap with anterior suspended flap in external dacryocystorhinostomy

Abstract

Aim: To compare the surgical outcome between anterior-posterior flap (APF) and anterior suspended flap (ASF) in external dacryocystorhinostomy (DCR). Settings and Design: This was a prospective, non-randomized, comparative, interventional, clinical study, done in J. P. M Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack. Materials and Methods: This was a single-centre hospital-based study on patients with primary nasolacrimal duct obstruction who underwent external DCR conducted during a period of 18 months. The patients were selected into either of the two procedures, that is, anterior-posterior flap external dacryocystorhinostomy (APF-DCR) or anterior suspended flap external dacryocystorhinostomy (ASF-DCR) and were reviewed at day 1, day 7, 1 month, 3 months, and 6 months postoperatively. Absence of epiphora was considered as the subjective success rate, whereas patent sac was considered as an objective success rate. Statistical Analysis Used: Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 13 software. Results: In our study, 131 patients underwent APF-DCR, whereas 133 underwent ASF-DCR. At the final follow-up, the subjective success rate was 88.3% and 87.7%, respectively, while the objective success rate at 6 months was 85.8% and 87.7% in the APF-DCR group and ASF-DCR group, respectively. However, there was no statistically significant difference between the groups, both subjectively and objectively. Intraoperative haemorrhage and other postoperative complications were very few in both the groups. Conclusions: We recommend performing ASF-DCR, as the suspension of anterior flaps prevents the possibility of granulation tissue formation at the rhinostomy site. Again, simultaneous suturing of the anterior flaps along with excision of the posterior flaps speeds up the procedure.