External Dacryocystorhinostomy Using Nasal Mucosal Flap Versus Non-Flap Technique: A Comparative Study in a Resource-Limited Setting

Open Access

Abstract

Background: Nasolacrimal duct obstruction (NLDO) is a typical ophthalmic disease that results in chronic epiphora and recurrent cases of dacryocystitis, and external dacryocystorhinostomy (Ext-DCR) is the gold standard surgical intervention. This study aimed to compare the outcomes of the surgical interventions of Ext-DCR with nasal mucosal flap and non-flap. Methods & Materials: This prospective comparative study was conducted at Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh from February 2017 to August 2017. 60 patients primarily affected with NLDO were assigned to two groups of the same size, Group A (flap, n=30) and Group B (non-flap, n=30). At 6 months after the surgical procedure, the outcome of the surgery was measured in terms of anatomical and functional measures. Data were entered and analyzed using SPSS version 26. Results: Every patient had epiphora; there was discharge in 60% (Group A) and 63.3% (Group B). The mean duration of surgery was much higher in the flap group (65.4 ± 8.2 vs. 52.6 ± 7.9 min; p<0.001). There were fewer complications in Group A after the operation surgery: no complication in 80% vs. 60. The success rate of anatomy was higher in Group A (93.3%) compared to Group B (80.0%) (p=0.138); the success rate of functionality was higher in Group A (90%) compared to Group B (73.3) (p=0.095). Two-thirds of 3.3% vs. 13.3% of cases required revision surgery. Conclusion: Ext-DCR nasal mucosal flap technique showed better anatomical and functional success, and reduced complications than the no-flap technique, indicating that it might be the technique of choice in situations when surgical expertise is at stake, and there are limited resources.