Meta-Analysis of Flaps Management in External Dacryocystorhinostomy

Abstract Background: Dacryocystorhinostomy (DCR) describes the creation of a functional pathway from the canaliculi into the nose through creating an osteotomy and opening the nasolacrimal sac into the nose. It can be performed via an external or endonasal approach. Aim of Study: To evaluate the outcomes of external DCR by using two different patterns of flap anastomosis; one only with anterior flap anastomosis and the other with both anterior and posterior flap anastomosis. Material and Methods: We followed the PRISMA state-ment guidelines Error! Bookmark not defined during this systematic review and meta-analysis preparation. All steps were performed according to the Cochrane handbook of systematic reviews of intervention. Results: The initial search resulted in 468 articles from five databases including PubMed, Cochrane, Scopus, Web of Science (WOS), Embase, and Science Direct. A total of ten studies were finally included for the final qualitative synthesis and the quantitative analysis. We identified ten studies com-paring double anterior and posterior mucosal flaps anastomosis versus single anterior mucosal in the surgical procedure of external dacryocystorhinostomy. The included studies focused on the outcomes of postoperative success rate, post-operative failure rate, perioperative complications including Intraoper-ative bleeding, Nasal mucosal tear, and Cheese wiring of punctum, we also focused on the postoperative bleeding score, Epiphora score, patency score, wound gaping, recurrence, mean surgical time, and the risk of watering eye. Conclusion: There was no difference in surgical success between single/double flap applications performed in external DCR operations. Also, Success rates were comparable between both techniques, and that the posterior mucosal flap has no role in the outcome of external DCR. Single flap anastomosis, external DCR can be implemented as a standard technique, without significantly compromising the final success rate. Anterior suspended flap external DCR is a simple, safe technique with a very high success rate and a satisfactory surgical time. No significant difference in terms of recurrence is seen in comparison to two flap anastomosis. Future rand-omized controlled trials (RCTs) with uniformity of the surgical components are warranted to validate these findings.