Endoscopic Dacryocystorhinostomy surgery's prognosis in patients with evaluation of histopathological features at lacrimal sac

Epiphora is a common complaint in otolaryngology and ophthalmology. The main goal of the epiphora treatment is to maintain the proper passage of the tear into the nasal cavity. This passage is provided when the medical treatment is insufficient. Recently, DSR is basically practiced in two ways; via endonasal route or via external route. En-DSR has more advantages when compared to external DSR in terms of recurrence formation and procedure application. Nevertheless, recurrences are common following the DSR operations. The objective of this study is to determine the recurrence rate of the patients following En-DSR procedure and to assess the relationship between histopathologic properties of the excised nasolacrimal sac and the recurrence rate of the disease.Patients who were assigned to this study were documented to have postsaccal lacrimal stenosis with a normal or diluted lacrimal sac following their evaluation at Departments of Otorhinolaryngology and Ophthalmology, and were directed to our clinic for En-DSR Seventy eight patients who had gone En-DSR between 1995?2010 in Celal Bayar University Department of Otolaryngology with diagnosis of chronic dacryocystitis are called for an interview and control examination. However, only 34 patients (%44) answered the call. These 34 patients were assessed for their age, sex, and follow up period, primary or revision surgery, silicon tubing application, simultaneous En-DCR with rhinologic surgery, presence of intraoperative and postoperative complications, presence of postoperative subjective complaints. Routine endoscopic examination and fluorescein test were performed to these patients.Histological scoring of the lacrimal sac specimens of 25 out of 34 (73.5%) control patients were examined for inflammatory cell infiltration, fibrosis, and chronic inflammation scores in terms of capillary proliferation were done at Department of Pathology of Celal Bayar University.Postoperative control period (p=0598), age (p=0502), gender (p=0649), silicone tube application (p=0249), En-DCR concurrent sinonasal surgery application (p=0541), primary/revision surgery (p=0.390) were not statistically significant for all cases., There was a statistically significant relationship between inflammatory cell infiltration (p=0.05), fibrosis (p=0.05), chronic inflammation score p=0.03) and recovery rates in 25 lacrimal sac preparations which were assessed by Department of Pathology. According to these results it was shown that as the lacrimal sac inflammation score severity increases, the success rate of the procedure decreases.It can be concluded that chronic inflammation scores are one of the criteria for the poor prognosis in terms of recurrence. Therefore, previous studies don?t suggest the routine histopathologic evaluation. However, according to the obtained data in this study, during En-DSR routine lacrimal sac biopsies must be done in order to identify the high risk patients for the recurrence with severe inflammatory score. These patients should be put on close follow up. Consequently, this study shows us the increase in lacrimal sac fibrosis, inflammatory cell infiltration and chronic inflammation scores affect the recovery negatively.