Search Results (1,212)

Objective: To evaluate the feasibility and short-term outcomes of a modified percutaneous endoscopic interlaminar discectomy (PEID) trajectory via the inferolateral margin of the L5 pedicle projection for central disc herniation at L5/S1. Methods: From June 2023 to July 2025, a consecutive cohort of 70 patients diagnosed with L5/S1 lumbar disc herniation (LDH) undergoing modified projection PEID was enrolled. Based on preoperative MRI (magnetic resonance imaging) evaluation of herniation types, they were divided into a central herniation group (n = 32) and a non-central herniation group (n = 38). Clinical outcomes and radiographic parameters were subsequently compared between the groups. Results: Seventy patients were included (38 non-central and 32 central). Baseline characteristics were comparable between the two groups except for a higher prevalence of bilateral symptoms in the central herniation group (p = 0.036). The central herniation group exhibited significantly shorter operative time (p = 0.027), reduced intraoperative blood loss (p = 0.047), and lower haemoglobin drop (p = 0.033). Multivariable linear regression confirmed that central herniation was independently associated with improved surgical efficiency. Both groups demonstrated significant postoperative improvements in VAS (Visual Analogue Scale) and JOA (Japanese Orthopaedic Association) scores. Although the non-central herniation group showed a higher JOA score on postoperative day 1 (p = 0.047), no significant differences were observed at 3 months or the final follow-up. The modified MacNab satisfaction rates were comparable (p = 0.411), with a similarly low complication rate in both groups. Conclusions: The modified PEID trajectory via the inferolateral margin of the L5 pedicle projection is feasible for central L5/S1 disc herniation and is associated with reduced operative time and decreased intraoperative blood loss. Full article

Background: Lumbar foraminal canal stenosis (LFS) is typically multifactorial: disk height loss and bulging, facet hypertrophy/osteophytes, ligamentous thickening, and post-inflammatory or post-interventional scarring. Methods: To develop and implement a structured system for surgical care in chronic vertebrogenic pain with radicular features attributable to LFS, integrating population-based MRI morphometrics and interventional therapy response profiling, we conducted a single-center, multi-cohort observational study to develop, operationalize, and internally evaluate a quantitative, volume-integrated diagnostic and treatment stratification framework for LFS. Results: A retrospective evaluation of 351 surgically treated patients (2017–2023) was performed to identify structural and clinical drivers of persistent or recurrent pain. Following selective blockades and radiofrequency denervation, radiculopathy regressed in 44.7% of patients, facet-mediated pain improved in 44.0%, and the median pain relief duration was 3–6 months. Oswestry Disability Index (ODI) dynamics after interventional therapy showed significant improvement at 6 months (all p < 0.001). Both groups demonstrated significant improvement in VAS, ODI, and SF-36 scores over time. Endoscopic decompression achieved faster early leg pain relief (VAS leg, p < 0.001 at 6 and 12 months). ALIF resulted in superior long-term back pain control (VAS back, p < 0.001 at 12 and 24 months). At 24 months, pain levels were clinically equivalent between groups, indicating that procedure selection influences pain profile rather than absolute outcome. Conclusions: By integrating quantitative foraminal volume, nerve occupancy, and segmental stability, we demonstrated that treatment success in LFS is not determined by the magnitude of decompression alone, but by the precision of phenotypic matching. Indirect decompression, endoscopic foraminotomy, microsurgical decompression, and fusion-based stabilization each have a rational role when aligned with the biomechanical context rather than applied reflexively. Full article

Introduction/Background: Large-volume benign prostatic hyperplasia (≥80 mL) requires complete anatomical removal of the adenoma. Robot-assisted or minimally invasive simple prostatectomy (RASP/MISP) and anatomic endoscopic enucleation of the prostate (AEEP) have both emerged as minimally invasive alternatives to open simple prostatectomy, but their comparative perioperative performance in very large glands remains incompletely defined. Objective: To systematically review and quantitatively synthesize the perioperative outcomes and complications of RASP/MISP versus AEEP in the surgical management of large-volume BPH. Methodology: Following PRISMA 2020, PubMed, Embase, Scopus and the Cochrane Library were searched from inception to 7 June 2026 for randomized and non-randomized comparative studies of RASP/MISP versus AEEP in men with mean or median prostate volume ≥ 80 mL reporting at least one perioperative or functional outcome and at least one Clavien–Dindo grade ≥ III complication. Continuous outcomes were pooled as mean differences (MD) and dichotomous outcomes as risk ratios using random-effects models (REML with Knapp–Hartung adjustment); heterogeneity was assessed with I². Risk of bias was evaluated with the Newcastle–Ottawa Scale and ROBINS-I, and certainty of evidence with GRADE. Publication bias and leave-one-out sensitivity analyses were performed where the number of studies permitted. Results: Five comparative cohort studies published between 2017 and 2025 were included, comprising 271 patients treated with RASP/MISP and 998 treated with AEEP. AEEP was associated with a significantly shorter catheterization time (pooled MD 5.95 days; 95% CI 1.98–9.92; p = 0.014) and a shorter hospital stay (pooled MD 2.73 days; 95% CI 1.07–4.39; p = 0.010), both with high heterogeneity (I² 99.0% and 96.1%, respectively). Perioperative hemoglobin drop tended to favor AEEP without reaching significance (pooled MD 0.65 g/dL; 95% CI −0.33 to 1.63; p = 0.103), and transfusion risk was lower but not statistically significant (pooled RR ≈ 0.46; 95% CI 0.18–1.15). PSA reduction was substantial and broadly equivalent between techniques. Functional outcomes (IPSS, QoL, Qmax, PVR) improved comparably with both approaches. Leave-one-out analyses confirmed that the catheterization and length-of-stay advantages of AEEP were robust, and no evidence of publication bias was detected. Certainty of evidence was low to moderate, reflecting the observational designs. Leave-one-out analyses indicated that the catheterization and length-of-stay differences were not driven by any single study; publication bias could not be assessed reliably because fewer than ten studies contributed to any outcome. Certainty of evidence was low to moderate, reflecting the observational designs, the small number of studies, and substantial between-study heterogeneity, and the findings should be regarded as hypothesis-generating. Conclusions: In large-volume BPH, AEEP and RASP/MISP achieve comparable functional improvement and adenoma debulking, but AEEP offers superior perioperative efficiency, with markedly shorter catheterization and hospital stay and at least comparable safety. RASP/MISP remains a valuable option where robotic infrastructure is available but high-volume enucleation expertise is lacking. These findings, drawn from observational evidence of low-to-moderate certainty, support AEEP as the more resource-efficient minimally invasive option for very large glands and underline the need for randomized comparative trials. Full article

Technological advances in spine surgery have allowed for significantly improved precision. Perhaps no technology has allowed for more personalized and precise surgery than endoscopic spine surgery. Although this technology has been around for decades, advancements in camera resolution have led to enhanced magnification and visualization of nerve root compression. Given our improved understanding of the interplay between spinal stability, spine pain, and muscle health, minimizing muscle disruption and bone resection has now become a key principle in spinal care. This narrative review will talk about common lumbar spine pathologies and how spinal endoscopy can be implemented to potentially improve patient care and outcomes. Full article

Background/Objectives: The increasing prevalence of antimicrobial resistance has become a major challenge in the management of Helicobacter pylori infection and is a leading cause of eradication failure. Resistance to clarithromycin and fluoroquinolones is primarily mediated by mutations in the 23S rRNA and gyrA genes, respectively. This study aimed to evaluate the prevalence of resistance-associated mutations in the 23S rRNA and gyrA genes, investigate their relationship with phenotypic antimicrobial resistance, assess their impact on eradication outcomes, and develop a prediction model for treatment failure. Methods: This retrospective real-world cohort study included 294 adult patients with confirmed H. pylori infection evaluated at the Oradea County Emergency Clinical Hospital, Romania, between November 2022 and November 2025. Clinical, endoscopic, histopathological, microbiological, molecular, and treatment outcome data were collected from medical records. Resistance-associated mutations in the 23S rRNA (A2143G, A2142G, and A2142C) and gyrA (N87K, D91G, and D91N) genes were analyzed and correlated with phenotypic antimicrobial resistance and eradication outcomes. Independent predictors of eradication failure were identified using multivariable logistic regression, and a prediction model was subsequently developed. Results: Overall, 101 patients (34.4%) harbored 23S rRNA mutations and 64 (21.8%) carried gyrA mutations, while 27 patients (9.2%) exhibited mutations in both genes. A2143G was the most frequent mutation (25.2%). Resistance-associated mutations showed strong concordance with phenotypic antimicrobial resistance. Patients with wild-type strains achieved eradication rates exceeding 90%, whereas significantly lower success rates were observed among patients carrying A2143G, A2142G, or gyrA mutations. Multivariable analysis identified previous eradication attempts (aOR 3.12, 95% CI 1.71–5.68), A2143G mutation (aOR 4.86, 95% CI 2.43–9.72), gyrA mutation (aOR 2.91, 95% CI 1.45–5.84), increasing age (aOR 1.03, 95% CI 1.01–1.05), and treatment with clarithromycin-based triple therapy (aOR 2.18, 95% CI 1.02–4.63) as independent predictors of eradication failure. The prediction model demonstrated excellent discriminatory performance (AUC 0.88, 95% CI 0.84–0.92), with a sensitivity of 82.5%, specificity of 80.1%, and satisfactory calibration (Hosmer–Lemeshow p = 0.68). Conclusions: Resistance-associated mutations in the 23S rRNA and gyrA genes are strongly associated with phenotypic antimicrobial resistance and reduced H. pylori eradication success. Molecular resistance testing may facilitate individualized treatment selection and improve clinical outcomes. The proposed prediction model, integrating clinical characteristics, treatment regimen, and molecular resistance markers, demonstrated excellent performance and may represent a useful tool for identifying patients at increased risk of eradication failure. Full article

Background/Objectives: Sinonasal osteomas are benign, slow-growing tumors that are typically asymptomatic and incidentally detected. However, in rare cases, they may present with atypical and potentially serious complications involving other sinonasal, orbital, or intracranial structures. This review aims to synthesize these unusual manifestations and to highlight the underlying mechanisms, diagnostic challenges, and management implications. Methods: A narrative review of the literature was conducted, focusing on reported cases of sinonasal osteomas with rare or complicated presentations. Studies were analyzed with emphasis on clinical features, imaging findings, pathophysiological mechanisms, and treatment strategies. Results: Unusual presentations of sinonasal osteomas are primarily driven by sinus obstruction, progressive expansion, and skull-base erosion. These processes may result in complications such as pneumocephalus, intracranial mucoceles, cerebrospinal fluid leaks, orbital compression, and secondary infections. Clinical manifestations are often nonspecific, including headache, seizures, visual disturbances, or focal neurological deficits, which may delay diagnosis. High-resolution computed tomography is essential for identifying the osseous lesion and associated bone changes, while magnetic resonance imaging is critical for assessing soft-tissue involvement and intracranial extension. Management is individualized, with surgical resection indicated in most symptomatic or complicated cases, using endoscopic, open, or combined approaches. Conclusions: Although rare, atypical manifestations of sinonasal osteomas can result in significant morbidity. A mechanism-based understanding, supported by appropriate imaging, is essential for accurate diagnosis and timely management. Increased clinical awareness is crucial to improving outcomes in these uncommon but clinically significant cases. Full article

Background: Despite growing evidence supporting the efficacy of dupilumab in the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), studies directly comparing biologic therapy with revision endoscopic sinus surgery remain limited. This study aimed to compare the effectiveness of dupilumab and revision endoscopic sinus surgery (ESS) in patients with recurrent CRSwNP. Methods: A retrospective cohort study was conducted in 50 patients with CRSwNP who had previously undergone at least two endoscopic sinus surgeries. Twenty-three patients received dupilumab, while twenty-seven underwent revision surgery. Changes in Nasal Polyp Score (NPS), quality of life assessed using the Sino-Nasal Outcome Test-22 (SNOT-22), and olfactory function evaluated with the Sniffin’ Sticks test were analyzed. Final clinical outcomes and the proportion of patients achieving very good disease control were also assessed. Results: Both treatment modalities improved disease control. However, dupilumab was associated with significantly greater reductions in NPS (median [IQR]: −6.00 [−6.00 to −5.00] vs. −4.00 [−6.00 to −3.00]; p = 0.012), larger improvements in SNOT-22 scores (−59.39 ± 12.14 vs. −21.37 ± 20.15; p < 0.001), and better recovery of olfactory function (+4.65 ± 2.79 vs. +2.19 ± 2.08; p = 0.001) compared with revision surgery. Analysis of final outcomes also favored dupilumab, with lower NPS scores (median [IQR]: 0.00 [0.00–1.00] vs. 1.00 [0.00–2.50]; p = 0.023), and better olfactory function (7.65 ± 3.11 vs. 4.78 ± 2.34; p < 0.001). Very good symptom control (SNOT-22 < 20) was achieved by 82.6% of patients treated with dupilumab compared with 7.4% of those undergoing revision surgery. Conclusions: Both revision surgery and dupilumab improved disease control in patients with CRSwNP. In this cohort, dupilumab was associated with greater reductions in disease severity, superior quality-of-life outcomes, and better olfactory function than revision endoscopic sinus surgery. Full article

The diagnostic evaluation of interstitial lung diseases (ILDs) remains challenging when clinical assessment and imaging findings are inconclusive. Although surgical lung biopsy has traditionally represented the diagnostic gold standard, its invasiveness and perioperative risks limit its applicability, particularly in patients with advanced disease or impaired respiratory reserve. This review aims to examine the evolving roles of transbronchial lung cryobiopsy (TBLC) and awake video-assisted thoracoscopic surgery (Awake VATS) within contemporary diagnostic pathways for ILD. A narrative review of the current literature was performed, focusing on studies evaluating the diagnostic performance, safety profiles, clinical indications, and complementary integration of TBLC and Awake VATS in patients with suspected ILD. Evidence from multidisciplinary ILD referral centers and recent guideline recommendations was critically analyzed. TBLC has progressively emerged as an appropriate first-line histological procedure in many ILD centers, providing a pooled diagnostic yield of approximately 80% with an acceptable safety profile. Awake VATS has refined the surgical approach by preserving spontaneous ventilation while maintaining high diagnostic accuracy. Current evidence suggests that these techniques should be considered complementary rather than competitive. A TBLC-first strategy, followed by selective surgical escalation when endoscopic sampling is non-diagnostic or insufficient, appears to achieve diagnostic accuracy comparable to upfront surgical biopsy while reducing complications, length of hospital stay, and overall patient burden. The choice between Awake VATS and conventional surgical biopsy should be individualized according to patient characteristics, institutional expertise, and available resources. TBLC and Awake VATS represent complementary tools within a multidisciplinary, personalized, and risk-adapted diagnostic framework for ILD. Their integrated use enables optimization of diagnostic accuracy while minimizing procedural invasiveness and improving patient safety, supporting a stratified approach to histological assessment in contemporary clinical practice. Full article

Accurate medical image segmentation remains challenging when lesions have large-scale variation, weak boundaries, and strong background interference. Vision Mamba provides efficient long-range modeling, but current Mamba-based U-shaped networks are still limited by weak local multi-scale representation and coarse skip fusion. This study proposes MSCF-Net, a Vision Mamba segmentation network for dermoscopic and endoscopic images. The network is built on VM-UNet and introduces two modules. The Multi-Scale Context Bridging (MSCB) module enriches bottleneck features with local, dilated, and global context. The Cross-Layer Adaptive Fusion (CLAF) module recalibrates encoder–decoder features in channel and spatial dimensions, reducing noisy shallow feature transmission. A structure loss is used to improve region completeness and boundary quality. Experiments on ISIC 2017, ISIC 2018, and CVC-ClinicDB show Dice scores of 90.62%, 90.82%, and 91.72%, and mIoU values of 82.02%, 82.31%, and 84.56%, respectively. Compared with representative baselines evaluated in our experiments, MSCF-Net achieves competitive segmentation performance under the adopted benchmark protocol. Ablation, qualitative, and spatial response analyses further indicate that MSCB improves scale-aware representation, while CLAF helps the decoder focus on lesion-related cues. The results suggest that MSCF-Net provides a favorable accuracy–efficiency trade-off for medical image segmentation. Full article

Background and Objectives: Endoscope-assisted posterior fossa decompression with duraplasty (PFDD) is a minimally invasive alternative treatment for Chiari I malformation; however, its comparative effectiveness remains unclear. Therefore, this study aimed to compare the outcomes of conventional open decompression with those of endoscope-assisted minimally invasive decompression combined with duraplasty to assess the balance between limited surgical exposure and associated technical challenges. Materials and Methods: This retrospective single-center study compared 22 patients who underwent endoscope-assisted PFDD with a historical cohort of 16 patients treated with conventional open PFDD. Patients with C1–2 instability, prior craniovertebral surgery, or concomitant pathology requiring an alternative surgical strategy were excluded. The clinical outcomes, radiological findings, surgical variables, and complications were analyzed. Results: Clinical improvement, overall recovery, and 3-month Chicago Chiari Outcome Scale (CCOS) scores were comparable between the groups. The endoscopic group had higher CCOS scores at discharge. Syrinx resolution rates were similar, whereas postoperative cisterna magna expansion was more limited in the endoscopic cohort. The endoscopic approach was associated with a significantly shorter incision length and earlier mobilization. The rates of complications, including pseudomeningocele, cerebrospinal fluid fistula, and wound infection, did not differ significantly between the groups. Conclusions: Endoscope-assisted PFDD may be a less invasive alternative with comparable short-term clinical and radiological outcomes. Despite the technical challenges related to a limited working corridor, it can be considered a feasible option for selected patients. Full article

Background and Objectives: Biliary strictures considered malignant or indeterminate at the time of endoscopic retrograde cholangiopancreatography (ERCP) frequently require endoscopic biliary drainage for biochemical improvement, symptom control, and continuation of diagnostic or oncologic management. This study aimed to evaluate the early and short-term real-world outcomes of ERCP-guided biliary stenting in patients with biliary strictures considered malignant or indeterminate at the time of ERCP, including cases in which malignancy was not subsequently confirmed. Materials and Methods: This single-center retrospective observational study screened 996 analyzable ERCP records performed between 27 February 2024 and 27 April 2026. The final cohort included 164 ERCP-guided biliary stenting procedures performed in 162 patients with suspected malignant or indeterminate biliary strictures. Clinical drainage success was defined according to the treating endoscopist’s documented assessment based on clinical improvement and/or biochemical bilirubin decline after stenting. Results: The median age was 60.0 years, and 87 procedures (53.0%) were performed in female patients. Definite malignancy was documented in 121 cases (73.8%). Distal strictures were the most common localization (72.0%). Clinical drainage success was achieved in 153 cases (93.3%). Median total bilirubin decreased from 1.50 mg/dL before ERCP to 0.42 mg/dL on post-ERCP day 14 (p < 0.001). ERCP-related adverse events occurred in 18 cases (11.0%), including post-ERCP pancreatitis in 10 cases (6.1%). Thirty-day mortality occurred in 2 cases (1.2%). Stent dysfunction and repeat ERCP were each observed in 23 cases (14.0%). Using a pre-ERCP total bilirubin threshold of >3.0 mg/dL, jaundice at presentation was present in 61 procedures (37.2%). Clinical drainage success was 91.8% in jaundiced procedures and 94.2% in non-jaundiced procedures. In a restricted multivariable model including only ASA physical status ≥3 and stent type, ASA physical status ≥3 showed an exploratory association with stent dysfunction (adjusted odds ratio: 4.84; 95% confidence interval: 1.36–17.23; p = 0.015). Although adverse event rates differed between plastic and metal stent groups, these comparisons were limited by baseline imbalance. Conclusions: ERCP-guided biliary stenting provided high clinical drainage success and significant early bilirubin reduction in patients with suspected malignant or indeterminate biliary strictures. Subgroup analyses suggested that stricture localization influenced real-world stent selection, whereas clinical drainage success and stent dysfunction did not differ significantly between distal and perihilar/hilar strictures. Stent dysfunction and repeat ERCP were required in a minority of cases, and higher ASA physical status showed an exploratory association with stent dysfunction, but this finding should be interpreted cautiously because of the limited number of dysfunction events. Stent-type comparisons should be interpreted cautiously because of real-world selection bias. Full article

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease associated with extraintestinal manifestations, including primary sclerosing cholangitis (PSC). Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that rarely coexists with UC or PSC. The concurrent occurrence of UC, PSC, and SLE in a single individual represents a unique diagnostic and therapeutic challenge. Vedolizumab, a gut-selective biologic agent, is effective for managing UC; however, its utility in patients presenting with this triad of conditions has not yet been explored. Case summary: A 32-year-old man presented with a 10-year history of recurrent upper abdominal pain, frequently accompanied by high-grade fever, along with recent onset of jaundice, diarrhea, hematochezia, and chronic rashes. Diagnostic evaluation confirmed PSC, SLE, and severe UC. During hospitalization, the patient also developed bacteremia. Initial management of UC with mesalazine and immunosuppressants (azathioprine followed by cyclosporine) resulted in limited clinical improvement. Vedolizumab was subsequently initiated, resulting in marked clinical improvements and near-complete endoscopic remission of UC. PSC and SLE remained clinically stable with ongoing therapies; however, the patient is currently awaiting liver transplantation for PSC. Conclusions: This case highlights the potential utility of vedolizumab in the treatment of UC in patients with concurrent PSC and SLE. Full article

Background/Objectives: Breast cancer is the most commonly diagnosed malignancy among women, with hormone receptor-positive tumors representing the majority of cases. Increasing survival rates have shifted attention toward long-term complications, including the risk of secondary malignancies. Emerging evidence suggests a potential association between breast cancer and gastrointestinal (GI) neoplasia. This study aimed to evaluate the role of colonoscopic and upper gastrointestinal endoscopic monitoring in patients with ER/PR-positive breast cancer and to assess its potential value in the early detection of digestive lesions. Methods: We conducted a prospective observational study including 186 female patients with histologically confirmed ER/PR-positive breast cancer. A total of 95 patients underwent colonoscopy, and 91 patients underwent upper gastrointestinal endoscopy. Clinical, demographic, and risk factor data were collected. A structured questionnaire was used to assess gastrointestinal symptoms. Endoscopic findings, lesion characteristics, and histopathological results were recorded. Bowel preparation quality was assessed using the Boston Bowel Preparation Scale. Results: Colonoscopy identified polyps and other lesions, with the majority located in the rectum and descending colon. A total of 12 biopsies were performed, revealing 1 malignant lesion, 2 borderline lesions, and the remainder benign. Upper gastrointestinal endoscopy showed gastritis as the most frequent finding, followed by gastric ulcers and polyps, while most patients had normal endoscopic results. Overall, 72% of patients presented at least one risk factor for digestive malignancy. Following treatment, most patients reported improvement in gastrointestinal symptoms. Conclusions: Patients with ER/PR-positive breast cancer may present a higher prevalence of gastrointestinal lesions, potentially related to shared risk factors and the systemic effects of endocrine therapy. Targeted, symptom-oriented endoscopic evaluation may facilitate early detection of premalignant and malignant digestive conditions. A multidisciplinary, risk-adapted surveillance approach should be considered to improve patient outcomes. Further large-scale studies are required to establish evidence-based screening strategies in this population. Full article

Background: Pediatric-onset inflammatory bowel disease (IBD) is a chronic relapsing condition leading to substantial morbidity and variable disease course. Early recognition of factors associated with suboptimal outcomes may improve risk stratification and therapeutic strategy. This retrospective cohort study intended to analyze the association between initial presentation characteristics and early disease course in pediatric-onset IBD. Methods: Included were pediatric patients diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) followed at the American University of Beirut Medical Center between 2013 and 2023. Demographic, anthropometric, laboratory, endoscopic, radiologic, and clinical data were gathered from medical records. Validated pediatric activity indices were used to assess severity, and early outcomes covered mainly the first remission. Results: Eighty-eight patients were evaluated for baseline characteristics, and eighty-one patients were analyzed for treatment outcomes. Among 88 subjects, 62.5% had CD and 37.5% had UC, with a mean age at diagnosis of 11.29 (±4.60) years. The most encountered presenting symptoms were abdominal pain, diarrhea, and hematochezia, with 44.9% of subjects having malnutrition. Clinical remission after initial treatment was obtained in 60.2% of subjects. A past medical history of autoimmune or inflammatory disease was linked to persistent symptoms, whereas initial use of corticosteroids was associated with early clinical remission. Conclusions: Pediatric IBD in our cohort was marked by extensive disease involvement, high inflammatory burden, nutritional impairment, and frequent flare or treatment escalation. Corticosteroid initiation at diagnosis was associated with early clinical remission in this retrospective cohort. Nevertheless, this association should be interpreted cautiously, as the retrospective design and potential confounding by indication limit any inference regarding causality or treatment superiority. The high rate of subsequent flare underscores the need for early risk stratification and individualized multidisciplinary care to improve long-term outcomes. Full article

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. Full article