External dacryocystorhinostomy: Double-flap anastomosis or excision of the posterior flaps?

To compare the results of external dacryocystorhinostomy (DCR), using two different patterns of flap anastomosis with creation of both sac and nasal mucosal anterior and posterior flaps: one that includes suturing of both flaps and the other that involves excision of the posterior flaps.

This randomized, clinical trial included 63 consecutive patients undergoing DCR. Patients were alternately assigned to two groups on the basis of the pattern of flap anastomosis. An H-shaped incision was created in the lacrimal sac and the nasal mucosa in all patients. In group A, posterior and anterior flaps were separately approximated; in group B, only the anterior flaps were sutured after resection of both posterior flaps. Postoperative hemorrhage, epiphora, and patency of the tract were assessed on follow-up visits. Final scores and success rates of the two groups were compared by using the Mann-Whitney U and chi.

The mean length of follow-up was 10.87 +/- 4.75 months for all patients. One patient in group B was lost to follow-up. The difference between the groups in postoperative bleeding, epiphora, and patency scores was found to be statistically insignificant (p = 0.451, p = 0.974, p = 0.583, respectively). The final success rates in groups A and B were 93.75% and 96.67%, respectively. There was no statistically significant difference in success rate between the groups (p = 0.593).

Our study suggests that DCR with double-flap anastomosis has no advantage over DCR with only anterior flaps. Anastomosis by suturing only anterior flaps and excision of the posterior flaps is easier to perform and does not appear to adversely affect the outcome of DCR surgery.