Minimally Invasive Surgery of Lachrymal Outflow: Comparison of Techniques with Presentation of a Novel Surgical Dacryocystectomy Variant

Abstract

Objective: The surgical treatment of epiphora and dacryocistitis includes Dacryocystorhinostomy (DCR) and Dacryocystectomy (DCT). To date, dacryocystectomy has been considered a secondary procedure and is not properly considered among the currently available surgical options. Intubation of the lacrimal system often improves surgical outcomes. In this study, a new variant of surgical technique, dacryocystectomy with lacrimal canalicula silicone intubation, is presented. All novel aspects and possible indications are discussed.Methods: Patients with chronic dacryocystitis associated with epiphora and lacrimal stenosis were enrolled for dacryocystectomy with silicon intubation. During follow-up, prevalence of epiphora, disease recurrences and adverse events have been investigated. Also, a retrospective clinical charts comparison with patients that received dacryocystorhinostomy ab externo has been performed.Results: No significant differences were found in terms of postoperative epiphora, silicon tube dislocation and overall adverse events have been observed between the compared groups (p>0.1). Persistent bleeding events were significantly more frequent in the DCR group (p<0.05). No severe adverse events were observed in both groups.Conclusions: Lacrimal intubation may improve classical dacryocystectomy outcomes with greater reduction of the epiphora. This technique, when well indicated (especially following a proper intraoperative clinical evaluation), may provide a decisive resolution of infective/inflammatory lacrimal affections and can avoid intra and postoperative complications associated with DCR.