Effectiveness of sodium hyaluronate (Protad) application in endoscopic endonasal dacryocystorhinostomy

Objective: To evaluate the effects of applying sodium hyaluronate solution (Protad) intraoperatively during endonasal dacryocystorhinostomy. Methods: A retrospective medical record review of all 254 patients (254 eyes) who underwent endonasal dacryocystorhinostomy for nasolacrimal duct obstruction was performed. The success rates and postoperative complications of the Protad application group (105 eyes) and the control group (149 eyes) were compared. Results: The Protad group had better anatomical (96.2% vs 86.6%, p = 0.010) and functional (93.3% vs 85.2%, p = 0.046) surgical success rates. Granuloma developed less frequently in the Protad group (11.4% vs 32.9%, p < 0.001). Regarding secondary outcomes, synechia was less frequent in the Protad group, but the difference was not statistically significant (p = 0.283). Crust and infection rates were also lower in the Protad group (6.7% vs 11.4% for crust, 7.6% vs 8.1% for infection), but the difference was not statistically significant (p = 0.203 and p = 0.899, respectively). The rate of revision surgery was significantly lower in the Protad group compared to the control group (1.9% vs 14.1%, p < 0.001). Granuloma had the largest effects on anatomical and functional surgical success (odds ratio, 72.221 for anatomical and 19.915 for functional). Conclusions: The application of Protad effectively reduced postoperative granulation and enhanced surgical success rate after endonasal dacryocystorhinostomy. We suggest that Protad is a good nasal dressing material, especially for beginners in endoscopic surgery who work on Asian patients with narrow nasal cavities.