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. 2022 Apr;279(4):1929-1935.
doi: 10.1007/s00405-021-06975-3. Epub 2021 Jul 12.

Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies

Alessandro Vinciguerra #  1   2 , Pietro Indelicato  1   2 , Antonio Giordano Resti  3 , Mario Bussi  1   2 , Matteo Trimarchi #  4   5
Affiliations

Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies

Alessandro Vinciguerra et al. Eur Arch Otorhinolaryngol. 2022 Apr.

Abstract

Purpose: Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction.

Methods: At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test.

Results: Among 14 patients included and after a mean follow-up of 19.5 months (range 13-51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported.

Conclusion: Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.

Keywords: Balloon dacryoplasty; Ballooning; Dacryocystorhinostomy; Nasolacrimal duct obstruction; Revision surgery.

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Conflict of interest statement

None of the authors have any conflict of interest.

Figures

Fig. 1
Fig. 1
Diagnostic work-up for failed DCRs. DCR: dacryocystorhinostomy; END-DCR: endoscopic endonasal dacryocystorhinostomy; CT: computed tomography
Fig. 2
Fig. 2
Endoscopic endonasal balloon-DCP: A Stenotic neorhinostomy (dashed white circle); B Trans-nasal introduction of the balloon catheter into the stenotic neorhinostomy; C Complete inflation of the catheter; D Enlarged neorhinostomy
Fig. 3
Fig. 3
Post-surgical follow-up: 28th post-operative day in patient A
Fig. 4
Fig. 4
Long-term post-operative follow-up: 12 months after surgery in patient B
See this image and copyright information in PMC

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