Surgical Outcomes of Revision Endoscopic Dacryocystorhinostomy with or Without Concomitant Septoplasty: A Retrospective Comparative Study

Background and Objectives: The combination of endoscopic dacryocystorhinostomy (En-DCR) and septoplasty enhances the surgical field, facilitating more effective treatment within the nasal cavity. This study compares the outcomes of revision En-DCR performed with or without concomitant septoplasty in patients with recurrent symptoms after primary En-DCR. Materials and Methods: A retrospective analysis was conducted on patients who underwent revision En-DCR after failure of primary En-DCR at our institution between March 2013 and June 2023. Patients were categorized into two groups: the revision En-DCR + septoplasty group and the revision En-DCR only group. Demographic information, intraoperative findings, and postoperative outcomes were thoroughly examined. Results: A total of 489 primary En-DCRs were performed on 381 patients, of whom 70.2% were female, with a mean age of 60.18 ± 14.38 years. Thirty-six patients (42 eyes, 8.6%) underwent revision En-DCR due to failed initial procedures, involving 30 unilateral and 6 bilateral cases. A total of 15 cases (35.7%) underwent combined endoscopic surgery with septoplasty, while 27 cases (64.3%) underwent revision En-DCR alone. Anatomical obstruction recurrences were observed in 1 case (6.7%) in the En-DCR + septoplasty group, whereas 6 cases (22.2%) experienced recurrence in the En-DCR-only group. The surgical success was numerically higher in the En-DCR + septoplasty group than in the En-DCR-only group (93.3% vs. 77.8%, p = 0.390). Conclusions: In this retrospective series, the combination of revision En-DCR with concomitant septoplasty yielded acceptable surgical outcomes despite more unfavorable nasal anatomy. This suggests that concomitant septoplasty can play a supportive role in revision cases by improving intranasal anatomy for anatomically challenging cases. However, because septoplasty was preferentially performed and the sample size was small, this study does not establish the independent benefit of septoplasty in revision En-DCR.