Long-term stability of results following surgery for obstructive sleep apnea (OSA).

PURPOSE: Although upper airway surgery in selected patients with obstructive sleep apnea (OSA) has been shown to be beneficial, its long-term effects have been questioned. The main objective was to evaluate whether results following surgery remain stable over time, both in objective and subjective terms. As a secondary aim, such stability was also measured in relation with the type of surgery performed. METHODS: This work constitutes a retrospective study of OSA adult patients subjected to the following surgical procedures: different types of pharyngoplasties, tongue-base surgery, partial epiglottectomy or hyoid suspension. Those who exclusively underwent tonsillectomy or nasal surgery were excluded. Before surgery, a sleep study, and an assessment of the patients' sleepiness and quality of life were performed, which were repeated at 8, 34, and 48 months after surgery. A total of 153 patients was included. RESULTS: Following surgery, the apnea-hypopnea index decreased from 34.84/h to 14.54/h and did not vary more than one point in subsequent controls (p = 0.01). The oxygen desaturation index changed from 31.02/h to 14.0/h and remained stable in the second (15.34/h) and third (11.43/h) controls (p = 0.01). Parameters measuring sleepiness and well-being demonstrated the maintenance of long-term benefits. New pharyngoplasties were observed to be more stable than classic pharyngoplasties in the long term (p = 0.04). Single-level surgeries were found to be more stable than multilevel surgeries, although a statistically significant difference was not observed (p = 0.07). CONCLUSION: The benefits obtained remained stable in the long term. In our sample, modern pharyngoplasty techniques showed superiority over the classic ones regarding long-term stability.

Faringoplastia de reposición modificada para el tratamiento del SAHS: cómo lo hacemos y nuestros resultados / Modified reposition pharyngoplasty for OSAS treatment: How we do it and our results

Introducción y objetivos: En los últimos 20años se ha descrito la relevancia de las paredes laterales faríngeas en el colapso de la vía aérea superior de pacientes con síndrome de apneas e hipopneas del sueño (SAHS). De ahí que hayan ido apareciendo nuevas técnicas quirúrgicas para mejorar este colapso. Nuestro objetivo es describir la técnica quirúrgica de la faringoplastia que realizamos y mostrar nuestros resultados iniciales.Material y métodosSe trata de un estudio retrospectivo en el que incluimos pacientes diagnosticados de SAHS que no toleran (o en los que no está indicado) el uso de CPAP. Los pacientes rellenaron un cuestionario previo a la cirugía en relación con sus hábitos de vida y con su roncopatía. Tras una exploración física completa tanto despierto como bajo somnoscopia, se procedió a esta intervención cuando observamos un colapso retropalatal y de paredes laterales faríngeas. En todos los pacientes se realizó un estudio de sueño preoperatorio así como entre los 3 y los 6meses tras la intervención, rellenando el mismo cuestionario en el postoperatorio a los 6meses. Calculamos la tasa de éxito según los criterios de Sher y, de una forma más restrictiva, según el criterio de índice de apnea-hipopnea (IAH) <10/h.ResultadosIncluimos un total de 26 pacientes, obteniendo un descenso significativo en el IAH de 29,1±18,3 a 12,3±12, sin cambios significativos en el IMC. Según criterios de Sher, en el 65,4% de los pacientes hubo un descenso del IAH a la mitad y <20/h, y el 42,3% del total consiguió un IAH <10/h. Obtuvimos resultados estadísticamente significativos en el resto de parámetros estudiados. La complicación más frecuente fue la extrusión parcial de la sutura.ConclusionesEsta cirugía obtiene resultados estadísticamente significativos tanto en los parámetros objetivos como subjetivos estudiados, sin complicaciones mayores asociadas. (AU)

Introduction and purposes: The relevance of the lateral pharyngeal walls in the collapse of the upper airway in obstructive sleep apnea patients has been revealed in the last 20years. New surgical techniques that address this collapse have been published. The aim of this study is to show the technique that we are currently using to treat the collapse and its results.Materials and methodsThis is a retrospective study of surgically treated OSAS patients who did not tolerate conventional positive airway pressure (CPAP) or for whom it was not indicated. After a complete physical examination either awake or under drug-induced sleep endoscopy, tonsillectomy with reposition pharyngoplasty was performed using barbed bidirectional suture and removing the supratonsillar fat. Three to 6months after surgery the subjective parameters were evaluated and a sleep study was performed.ResultsTwenty-six patients were enrolled with a significative decrease in the AHI and also significative improvement in all the rest parameters studied. In 65.4% of the patients the AHI decreased 50% and was lower than 20/h, in 42.3% postoperative AHI was lower than 10/h. The most frequent complication was the partial extrusion of the suture.ConclusionsThis surgical procedure obtains statistically significant results in objective and subjective parameters of sleep apnoea without major associated complications. (AU)

¿Pueden los biomarcadores inflamatorios ayudar al diagnóstico y predecir el pronóstico de la colecistitis aguda gangrenosa? Un estudio prospectivo / No disponible

INTRODUCCIÓN: el diagnóstico de la colecistitis aguda gangrenosa constituye un reto diagnóstico para el médico y en pocas ocasiones se realiza de manera preoperatoria. MATERIAL Y MÉTODOS: presentamos un estudio longitudinal prospectivo de 180 pacientes a los que se les realiza colecistectomía secundaria a colecistitis aguda. Se realiza curva ROC para determinar el punto de corte preoperatorio de diferentes biomarcadores (ratio neutrófilo-linfocito [RNL], proteína C reactiva [PCR], ratio plaqueta-linfocito [RPL], lactato y procalcitonina) y asociación con hallazgos perioperatorios y postoperatorios. RESULTADOS: el área bajo la curva para RNL, PCR, RPL, lactato y procalcitonina fue de 0,75, 0,8, 0,65 y 0,6, respectivamente. CONCLUSIÓN: RNL > 5 y PCR > 100 permanecen como factores independientes de gangrena (odds ratio [OR] ajustada de 2 y 2,1, respectivamente)

No disponible

Modified reposition pharyngoplasty for OSAS treatment: How we do it and our results. / Faringoplastia de reposición modificada para el tratamiento del SAHS: cómo lo hacemos y nuestros resultados.

INTRODUCTION AND PURPOSES: The relevance of the lateral pharyngeal walls in the collapse of the upper airway in obstructive sleep apnea patients has been revealed in the last 20years. New surgical techniques that address this collapse have been published. The aim of this study is to show the technique that we are currently using to treat the collapse and its results. MATERIALS AND METHODS: This is a retrospective study of surgically treated OSAS patients who did not tolerate conventional positive airway pressure (CPAP) or for whom it was not indicated. After a complete physical examination either awake or under drug-induced sleep endoscopy, tonsillectomy with reposition pharyngoplasty was performed using barbed bidirectional suture and removing the supratonsillar fat. Three to 6months after surgery the subjective parameters were evaluated and a sleep study was performed. RESULTS: Twenty-six patients were enrolled with a significative decrease in the AHI and also significative improvement in all the rest parameters studied. In 65.4% of the patients the AHI decreased 50% and was lower than 20/h, in 42.3% postoperative AHI was lower than 10/h. The most frequent complication was the partial extrusion of the suture. CONCLUSIONS: This surgical procedure obtains statistically significant results in objective and subjective parameters of sleep apnoea without major associated complications.

Can inflammatory biomarkers help in the diagnosis and prognosis of gangrenous acute cholecystitis? A prospective study.

The diagnosis of gangrenous acute cholecystitis represents a diagnostic challenge for the physician and is rarely identified preoperatively. We report a longitudinal prospective study in 180 patients who underwent cholecystectomy for acute cholecystitis. A ROC curve was obtained to determine the preoperative cut-off for various biomarkers (neutrophil to lymphocyte ratio [NLR], C-reactive protein [CRP], platelet to lymphocyte ratio [PLR], lactate and procalcitonin) and their association with both preoperative and postoperative findings. The area under the curve (AUC) for NLR, CRP, PLR, lactate and procalcitonin was 0.75, 0.8, 0.65 and 0.6, respectively. NLR > 5 and CRP > 100 are still independent factors for gangrene (adjusted odds ratio [OR], 2 and 2.1, respectively).

Mejorando los resultados quirúrgicos de las faringoplastias: nuestra experiencia en la última década / Improving surgical results in velopharyngeal surgery: our experience in the last decade

ANTECEDENTES Y OBJETIVO: Las técnicas quirúrgicas para tratar el colapso velofaríngeo de los pacientes con síndrome de apnea-hipopnea del sueño han evolucionado en los últimos años. Nuestro objetivo era conocer si estas nuevas técnicas proporcionan mejores resultados quirúrgicos. MATERIALES Y MÉTODOS: Es un estudio retrospectivo de los pacientes con síndrome de apnea-hipopnea del sueño moderado-severo tratados quirúrgicamente del 2006 al 2018. Solo los pacientes adultos sin adherencia a la CPAP y en los que no se practicó cirugía multinivel simultánea fueron incluidos. Durante este período se practicaron 4 técnicas diferentes: resección parcial del paladar, faringoplastia lateral, faringoplastia de expansión y faringoplastia de reposición con sutura barbada. La tasa de éxito se calcula según los criterios de Sher, según el criterio de IAH < 10/h y mediante la reducción relativa media del IAH (RRM). RESULTADOS: Ochenta y dos pacientes fueron incluidos. El IAH se redujo significativamente de 43,4 ± 24/h a 15,6 ± 18,6/h. No se observaron cambios significativos en el índice de masa corporal. Los valores de Tc 90, el índice de desaturación y la somnolencia según la escala de Epworth mejoraron tras la cirugía. La mayor tasa de éxito se obtuvo mediante la realización de la faringoplastia de reposición con sutura barbada (78,26% según criterios Sher, 65,22% para IAH < 10/h y 74,1% en RRM). Las diferencias observadas fueron estadísticamente significativas. CONCLUSIONES: La faringoplastia de reposición con sutura barbada es una técnica de reciente introducción que mostró superioridad sobre el resto de faringoplastias en esta cohorte

BACKGROUND AND PURPOSE: The surgical techniques used to treat velopharyngeal collapse in obstructive sleep apnoea patients have evolved over recent years. Our aim was to determine whether these new techniques have better surgical results. MATERIALS AND METHODS: This is a retrospective study of moderate to severe obstructive sleep apnoea patients surgically treated from 2006 to 2018. Only adult patients with no compliance to positive airway pressure and without simultaneous multilevel surgery were included. During this period, 4 different techniques were performed: uvulopalatopharyngoplasty, lateral pharyngoplasty, expansion pharyngoplasty and barbed reposition pharyngoplasty. Success rates as defined by Sher, as well as postoperative AHI < 10/h and mean relative AHI reduction (MRR) were compared. RESULTS: 82 patients were included. AHI was significantly reduced from 43.4 ± 24/h to 15.6 ± 18.6/h. No significant changes in body mass index were observed. Hypoxaemia time, oxygen desaturation index, and Epworth sleepiness scale values improved after surgery. The best success rates were obtained performing barbed reposition pharyngoplasty (78.26% measured by Sher's criteria, 65.22% by AHI < 10/h criteria and 74.1% by the MRR). The differences observed were statistically significant. CONCLUSIONS: Barbed reposition pharyngoplasty is a recently introduced technique that showed superiority over the other palatal surgery techniques in this cohort

Improving surgical results in velopharyngeal surgery: our experience in the last decade. / Mejorando los resultados quirúrgicos de las faringoplastias: nuestra experiencia en la última década.

BACKGROUND AND PURPOSE: The surgical techniques used to treat velopharyngeal collapse in obstructive sleep apnoea patients have evolved over recent years. Our aim was to determine whether these new techniques have better surgical results. MATERIALS AND METHODS: This is a retrospective study of moderate to severe obstructive sleep apnoea patients surgically treated from 2006 to 2018. Only adult patients with no compliance to positive airway pressure and without simultaneous multilevel surgery were included. During this period, 4 different techniques were performed: uvulopalatopharyngoplasty, lateral pharyngoplasty, expansion pharyngoplasty and barbed reposition pharyngoplasty. Success rates as defined by Sher, as well as postoperative AHI<10/h and mean relative AHI reduction (MRR) were compared. RESULTS: 82 patients were included. AHI was significantly reduced from 43.4±24/h to 15.6±18.6/h. No significant changes in body mass index were observed. Hypoxaemia time, oxygen desaturation index, and Epworth sleepiness scale values improved after surgery. The best success rates were obtained performing barbed reposition pharyngoplasty (78.26% measured by Sher's criteria, 65.22% by AHI<10/h criteria and 74.1% by the MRR). The differences observed were statistically significant. CONCLUSIONS: Barbed reposition pharyngoplasty is a recently introduced technique that showed superiority over the other palatal surgery techniques in this cohort.