201 results on '"Postoperative dysphagia"'
Search Results
2. Development of predictive score for postoperative dysphagia after emergency abdominal surgery in patients of advanced age.
- Author
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Iguchi, Tomohiro, Mita, Junya, Iseda, Norifumi, Sasaki, Shun, Harada, Noboru, Ninomiya, Mizuki, Sugimachi, Keishi, Honboh, Takuya, Sadanaga, Noriaki, and Matsuura, Hiroshi
- Subjects
SURGICAL emergencies ,ABDOMINAL surgery ,DEGLUTITION disorders ,RECEIVER operating characteristic curves ,VIDEOFLUOROSCOPY ,CEREBROVASCULAR disease - Abstract
Aim: Postoperative dysphagia after emergency abdominal surgery (EAS) in patients of advanced age has become problematic, and appropriate dysphagia management is needed. This study was performed to identify predictive factors of dysphagia after EAS and to explore the usefulness of swallowing screening tools (SSTs). Methods: This retrospective study included 267 patients of advanced age who underwent EAS from 2012 to 2022. They were assigned to a dysphagia group and non‐dysphagia group using the Food Intake Level Scale (FILS) (dysphagia was defined as a FILS level of <7 on postoperative day 10). From 2018, original SSTs including a modified water swallowing test were performed by nurses. Results: The incidence of postoperative dysphagia was 22.8% (61/267). Patients were significantly older in the dysphagia than non‐dysphagia group. The proportions of patients who had poor nutrition, cerebrovascular disorder, Parkinson's disease, dementia, nursing‐care service, high intramuscular adipose tissue content (IMAC), and postoperative ventilator management were much higher in the dysphagia than non‐dysphagia group. Using logistic regression analysis, high IMAC, postoperative ventilator management, cerebrovascular disorder, and dementia were correlated with postoperative dysphagia and were assigned 10, 4, 3, and 3 points, respectively, according to each odds ratio. The optimal cut‐off value was 7 according to a receiver operating characteristics curve. Using 1:1 propensity score matching for high‐risk patients, the incidence of postoperative dysphagia was reduced by SSTs. Conclusions: The new prediction score obtained from this study can identify older patients at high risk for dysphagia after EAS, and SSTs may improve these patients' short‐term outcomes. This retrospective study included 267 patients of advanced age and was performed to identify predictive factors of dysphagia after emergency abdominal surgery and to explore the usefulness of swallowing screening tools. This study demonstrated that high intramuscular adipose tissue content, postoperative ventilator management, cerebrovascular disorder, and dementia were associated with postoperative dysphagia after emergency abdominal surgery in patients of advanced age. For patients at high risk as identified by our new prediction score that was created based on these risk factors, propensity score‐matching analysis showed that the use of swallowing screening tools can help to prevent postoperative dysphagia. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
3. Fiberoszkóppal végzett funkcionális nyelésvizsgálat bevezetése és indikációs körének kiterjesztése klinikánkon.
- Author
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Ambrus, Andrea, Rovó, László, Sztanó, Balázs, Burián, András, Molnár-Tóth, Alinka, and Bach, Ádám
- Abstract
Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2023
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4. Intraoperative occipital to C2 angle and external acoustic meatus-to-axis angular measurements for optimizing alignment during posterior fossa decompression and occipitocervical fusion for complex Chiari malformation.
- Author
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Han, Rachael, Chae, John, Garton, Andrew, Cruz, Amanda, Navarro-Ramirez, Rodrigo, Hussain, Ibrahim, Härtl, Roger, and Greenfield, Jeffrey
- Subjects
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ARNOLD-Chiari deformity , *NECK pain , *ANGULAR measurements , *SURGICAL complications , *ANGLES , *MORPHOMETRICS , *LAMINECTOMY , *REOPERATION - Abstract
Background: Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications, such as dysphagia, respiratory problems, line of sight issues, and neck pain, but posterior fossa decompression (PFD) and OCF require different positions that require intraoperative manipulation. Objective: The objective of this study was to describe quantitative fluoroscopic morphometrics in Chiari malformation (CM) patients with symptoms of craniocervical instability (CCI) and demonstrate the intraoperative application of these measurements to achieve neutral craniocervical alignment while leveraging a single axis of motion with the Mayfield head clamp locking mechanism. Methods: A retrospective cohort study of patients with CM 1 and 1.5 and features of CCI who underwent PFD and OCF at a single-center institution from March 2015 to October 2020 was performed. Patient demographics, preoperative presentation, radiographic morphometrics, operative details, complications, and clinical outcomes were analyzed. Results: A total of 39 patients met the inclusion criteria, of which 37 patients (94.9%) did not require additional revision surgery after PFD and OCF. In this nonrevision cohort, preoperative to postoperative occipital to C2 angle (O-C2a) (13.5° ± 10.4° vs. 17.5° ± 10.1°, P = 0.047) and narrowest oropharyngeal airway space (nPAS) (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = 0.007) increased significantly. These measurements were decreased in the two patients who required revision surgery due to postoperative dysphagia (mean difference – 16.6°° in O C2a and 12.8°° in occipital and external acoustic meatus to axis angle). Based on these results, these fluoroscopic morphometrics are intraoperatively assessed, utilizing a locking Mayfield head clamp repositioning maneuver to optimize craniocervical alignment prior to rod placement from the occipital plate to cervical screws. Conclusion: Establishing a preoperative baseline of reliable fluoroscopic morphometrics can guide surgeons intraoperatively in appropriate patient realignment during combined PFD and OCF, and may prevent postoperative complications. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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5. Intraoperative occipital to C2 angle and external acoustic meatus-to-axis angular measurements for optimizing alignment during posterior fossa decompression and occipitocervical fusion for complex Chiari malformation
- Author
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Rachael K Han, John K Chae, Andrew L A Garton, Amanda Cruz, Rodrigo Navarro-Ramirez, Ibrahim Hussain, Roger Härtl, and Jeffrey P Greenfield
- Subjects
chiari malformation ,craniocervical instability ,fluoroscopic morphometrics ,occipitocervical fusion ,postoperative dysphagia ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Background: Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications, such as dysphagia, respiratory problems, line of sight issues, and neck pain, but posterior fossa decompression (PFD) and OCF require different positions that require intraoperative manipulation. Objective: The objective of this study was to describe quantitative fluoroscopic morphometrics in Chiari malformation (CM) patients with symptoms of craniocervical instability (CCI) and demonstrate the intraoperative application of these measurements to achieve neutral craniocervical alignment while leveraging a single axis of motion with the Mayfield head clamp locking mechanism. Methods: A retrospective cohort study of patients with CM 1 and 1.5 and features of CCI who underwent PFD and OCF at a single-center institution from March 2015 to October 2020 was performed. Patient demographics, preoperative presentation, radiographic morphometrics, operative details, complications, and clinical outcomes were analyzed. Results: A total of 39 patients met the inclusion criteria, of which 37 patients (94.9%) did not require additional revision surgery after PFD and OCF. In this nonrevision cohort, preoperative to postoperative occipital to C2 angle (O-C2a) (13.5° ± 10.4° vs. 17.5° ± 10.1°, P = 0.047) and narrowest oropharyngeal airway space (nPAS) (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = 0.007) increased significantly. These measurements were decreased in the two patients who required revision surgery due to postoperative dysphagia (mean difference – 16.6°° in O C2a and 12.8°° in occipital and external acoustic meatus to axis angle). Based on these results, these fluoroscopic morphometrics are intraoperatively assessed, utilizing a locking Mayfield head clamp repositioning maneuver to optimize craniocervical alignment prior to rod placement from the occipital plate to cervical screws. Conclusion: Establishing a preoperative baseline of reliable fluoroscopic morphometrics can guide surgeons intraoperatively in appropriate patient realignment during combined PFD and OCF, and may prevent postoperative complications.
- Published
- 2023
- Full Text
- View/download PDF
6. Prospective Comparative Study of Dysphagia after Subaxial Cervical Spine Surgery: Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament Ossification.
- Author
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Sakaki, Kyohei, Sakai, Kenichiro, Arai, Yoshiyasu, Torigoe, Ichiro, Tomori, Masaki, Hirai, Takashi, Onuma, Hiroaki, Kobayashi, Yutaka, Okawa, Atsushi, and Yoshii, Toshitaka
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CERVICAL spondylotic myelopathy , *LONGITUDINAL ligaments , *CERVICAL vertebrae , *OSSIFICATION , *DISEASE risk factors - Abstract
We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
7. Cervical Deformity Patients Have Baseline Swallowing Dysfunction but Surgery Does Not Increase Dysphagia at 3 Months: Results From a Prospective Cohort Study
- Author
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Iyer, Sravisht, Kim, Han Jo, Bao, Hongda, Smith, Justin S, Protopsaltis, Themistocles S, Mundis, Gregory M, Passias, Peter, Neuman, Brian J, Klineberg, Eric O, Lafage, Virginie, and Ames, Christopher P
- Subjects
Clinical Research ,Patient Safety ,Evaluation of treatments and therapeutic interventions ,6.4 Surgery ,Oral and gastrointestinal ,cervical deformity ,dysphagia ,SWAL-QOL ,complications ,adult spinal keywords ,deformity ,posterior cervical surgery ,revision cervical surgery ,postoperative dysphagia ,cervical ,International Spine Study Group ,adult spinal keywords: deformity - Abstract
Study designProspective cohort study.ObjectivesMost studies of dysphagia in the cervical spine have focused on a degenerative patient population; the rate of dysphagia following surgery for cervical deformity (CD) is unknown. This study aims to investigate if surgery for cervical deformity results in postoperative dysphagia.MethodsPatients with CD undergoing surgery from 2013 to 2015 were prospectively enrolled to evaluate dysphagia. Demographic, operative, and radiographic variables were analyzed. The Quality of Life in Swallowing Disorders (SWAL-QoL) was used to measure dysphagia. Paired t test, independent t tests, and bivariate Pearson correlations were performed.ResultsA total of 88 CD patients, aged 61.52 ± 10.52 years, were enrolled. All patients (100%) had 3-month SWAL-QoL for analysis. The baseline preoperative SWAL-QoL was 78.35. This is roughly the same level of dysphagia as an anterior cervical discectomy patient that is 3 weeks removed from surgery. Increasing body mass index (BMI) was correlated with decreased SWAL-QoL score (r = -0.30, P = .001). Age, gender, smoking, and Charlson Comorbidity Index (CCI) showed no significant correlations with preoperative SWAL-QoL. Patients with prior cervical surgery had a lower preoperative SWAL-QoL (P = .04). While 11 patients had acute postoperative dysphagia, CD surgery did not result in lower SWAL-QoL at 3 months (77.26 vs 78.35, P = .53). Surgical variables, including estimated blood loss (EBL), anterior or posterior fusion levels, steroid use, preoperative traction, staged surgery, surgical approach, anterior corpectomy, posterior osteotomy, and UIV (upper instrumented vertebrae) location, showed no impact on postoperative SWAL-QoL. Correction of cervical kyphosis was not correlated to 3-month SWAL-QoL scores or the change in SWAL-QoL scores.ConclusionsWhile patients undergoing surgery for cervical deformity had swallowing dysfunction at baseline, we did not observe a significant decline in SWAL-QoL scores at 3 months. Patients with prior cervical surgery and higher BMI had a lower baseline SWAL-QoL. There were no surgical or radiographic variables correlated to a change in SWAL-QOL score.
- Published
- 2019
8. Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report
- Author
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Shinsuke Yamamoto, Masanori Nashi, Keigo Maeda, Naoki Taniike, and Toshihiko Takenobu
- Subjects
Mandibular fracture ,Severe intellectual disability ,Postoperative dysphagia ,Dysphagia rehabilitation ,Medicine - Abstract
Abstract Background The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. Case presentation A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient’s mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. Conclusions The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.
- Published
- 2022
- Full Text
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9. Analysis of risk factors for postoperative dysphagia after C1-2 fusion
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Dong Sun, Jianhui Mou, Zhaolin Wang, and Peng Liu
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postoperative dysphagia ,C1-2 fusion surgery ,oropharyngeal space ,cervical sagittal alignment ,risk factors ,Surgery ,RD1-811 - Abstract
ObjectiveThis study aimed to analyze the risk factors for dysphagia after C1-2 fusion in patients with C1-2 junction diseases.Summary of the background dataDysphagia is a common postoperative complication of posterior C1-2 junction surgery. The incidence is 9.5% to 26.3%. However, the etiopathogenisis of postoperative dysphagia remains controversial.MethodsThis retrospective study included patients who underwent C1-2 fusion from January 2016 to January 2020. The patients were divided into dysphagia group and control group in accordance with the Bazaz R dysphagia scoring system. The patients' age, gender, BMI(body mass index), cause of disease, and changes in the C01cobb, C02cobb, C12cobb, C27cobb, dC02cobb, dC01cobb, dC12cobb, d C27cobb angles before and after operation, were recorded. The parameters and changes were compared to analyze the risk factors for dysphagia after C1-2 fusion.Results65 cases (15, with dysphagia; 50, without dysphagia) were included. The incidence of postoperative dysphagia was 23%. The differences in age, gender ratio, and BMI between the two groups were not significant (P > 0.05). The differences among postoperative C12 (29.8° ± 11.24° vs. 20.46° ± 13.39°), postoperative C27cobb (10.56° ± 8.53° vs. 20.21° ± 13.21°), and dC12cobb (9.49° ± 5.16° vs. 1.07° ± 12.44°) between the two groups were significant (P 5° was a significant independent risk factor for postoperative dysphagia, And preoperative C27cobb was a preventive factor of postoperative dysphagia.ConclusionsDysphagia after the C1-2 fusion was common. dC02cobb and dC12cobb were the significant independent risk factors for postoperative dysphagia. Preoperative c27cobb was a preventive factor of dysphagia.
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- 2022
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10. Management of Patient with Lumbar PIVD
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Yuan, Adam Yu, Singh, Saket, Prabhakar, Hemanshu, editor, Rajan, Shobana, editor, Kapoor, Indu, editor, and Mahajan, Charu, editor
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- 2020
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11. Clinical outcomes following one-, two-, three-, and four-level anterior cervical discectomy and fusion: a national database study.
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Joo, Peter Y., Zhu, Justin R., Kammien, Alexander J., Gouzoulis, Michael J., Arnold, Paul M., and Grauer, Jonathan N.
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DISCECTOMY , *SPINAL fusion , *TREATMENT effectiveness , *UNIVARIATE analysis , *OPERATIVE surgery , *MULTIVARIATE analysis , *REOPERATION - Abstract
Background Context: Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure. There is markedly less data on outcomes after three- and four-level cases than one- and two-level cases.Purpose: To compare perioperative 90-day adverse events and 5-year reoperation rates between isolated one-, two-, three-, and four-level ACDF cases.Study Design/setting: Retrospective review of a large national database.Patient Sample: Overall, 97,081 patients undergoing ACDF were identified, of which one-level cases were 42,382 (43.7%), two-level cases were 24,055 (24.8%), three-level cases were 28,293 (29.1%), and four-level cases were 2,361 (2.4%).Outcome Measures: Ninety-day adverse events and 5-year reoperation rates.Methods: The 2010 to Q1 2020 PearlDiver database was queried to identify patients who underwent elective ACDF for degenerative pathology without corpectomy or concomitant posterior procedures. Univariate and multivariate analyses were performed to compare outcomes of subcohorts with varying number of levels addressed by ACDF.Results: Of the 97,081 cases identified, patient characteristics and complication rates differed between the cohorts defined by levels treated. Univariate analyses revealed statistically different rates of 90-day any, serious, and minor adverse event rates between the groups, but the differences were all less than 2.5%. Readmission rates were statistically different by 2.9%, dysphagia by 3.2%, and prolonged length of stay by 6.3%.By multivariate analyses, three-level ACDF cases were not found to have greater 90-day adverse outcomes than two-level cases. Four-level ACDF cases were found to have significantly greater odds ratios of readmission, dysphagia, and prolonged length of stay (relative to one-level cases, OR 1.28, 1.63, and 1.97, respectively) but not other 90-day adverse events. Reoperation rates at five years for one-, two-, three-, and four-level cases were 13.0%, 13.5%, 15.0%, and 22.1%, respectively (log-rank p<.001).Conclusions: The current study represents one of the largest comparative studies of patients undergoing one-, two-, three-, and four-level ACDF. While odds of 90-day adverse events were not greater for three- versus two-level cases, four-level cases had several that were higher odds than one-level cases. Reoperation and dysphagia rates were higher for four-level cases than lesser levels. While these outcomes were found to be acceptable, they should help guide hospital planning and patient counseling. [ABSTRACT FROM AUTHOR]- Published
- 2022
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12. Predictive ability of pharyngeal inlet angle for the occurrence of postoperative dysphagia after occipitocervical fusion
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Lin-nan Wang, Bo-wen Hu, Yue-ming Song, Li-min Liu, Chun-guang Zhou, Lei Wang, and Xi Yang
- Subjects
Occipitocervical fusion ,Postoperative dysphagia ,O-EAa ,PIA ,Prediction ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF). Methods Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia. Results Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA
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- 2021
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13. Prospective Comparative Study of Dysphagia after Subaxial Cervical Spine Surgery: Cervical Spondylotic Myelopathy and Posterior Longitudinal Ligament Ossification
- Author
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Kyohei Sakaki, Kenichiro Sakai, Yoshiyasu Arai, Ichiro Torigoe, Masaki Tomori, Takashi Hirai, Hiroaki Onuma, Yutaka Kobayashi, Atsushi Okawa, and Toshitaka Yoshii
- Subjects
ossification of the posterior longitudinal ligament ,cervical spondylotic myelopathy ,surgical complication ,postoperative dysphagia ,Medicine - Abstract
We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases.
- Published
- 2023
- Full Text
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14. Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report.
- Author
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Yamamoto, Shinsuke, Nashi, Masanori, Maeda, Keigo, Taniike, Naoki, and Takenobu, Toshihiko
- Subjects
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DEGLUTITION disorders , *MANDIBULAR fractures , *DISABILITIES , *INTELLECTUAL disabilities , *TREATMENT of fractures , *PERCUTANEOUS endoscopic gastrostomy - Abstract
Background: The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability.Case Presentation: A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient's mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required.Conclusions: The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
15. Revision of a Failed C5-7 Corpectomy Complicated by Esophageal Fistula Using a 3-Dimensional−Printed Zero-Profile Patient-Specific Implant: A Technical Case Report.
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Amin, Tajrian, Lin, Henry, Parr, William C.H., Lim, Patrick, and Mobbs, Ralph J.
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ESOPHAGEAL fistula , *TECHNICAL reports , *DEGLUTITION disorders , *FISTULA , *FRACTURE fixation , *SPINAL surgery , *DISCECTOMY - Abstract
Esophageal fistulae are rare, though serious, complications of anterior cervical surgery. Hardware-related issues are important etiologic factors. Patient-specific implants (PSIs) have increasingly been adapted to spinal surgery and offer a range of benefits. Zero-profile implants are a recent development primarily aimed at combating postoperative dysphagia. We report the first use of a 3-dimensional (3D)-printed zero-profile PSI in managing implant failure with migration and a secondary esophageal fistula. A 68-year-old female had a prior C5-7 corpectomy with cage and plate fixation, as well as posterior C3-T1 lateral mass fixation, complicated by anterior plate displacement, resulting in pseudoarthrosis and an esophageal fistula. A 3D-printed zero-profile PSI was designed and implanted as part of a revision procedure to assist in recovery, prevent recurrence, and facilitate bony fusion. Optimal implant placement was achieved on the basis of preoperative virtual surgical planning. By 1 month postoperatively the patient had significantly improved, with evidence of esophageal fistula resolution and radiographic evidence of optimal implant placement. Zero-profile 3D-printed PSIs may combat common and serious complications of anterior cervical surgery including postoperative dysphagia and esophageal fistulae. Further research is required to validate their widespread use for either cervical corpectomy or diskectomy and interbody fusion. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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16. Dysphagia After Laparoscopic Nissen Fundoplication: Incidence, Causes, Prevention, and Treatment
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Schietroma, Mario, Romano, Lucia, Tomarelli, Chiara, Carlei, Francesco, Tonelli, Emilio, and Giuliani, Antonio
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- 2022
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17. Predictive ability of pharyngeal inlet angle for the occurrence of postoperative dysphagia after occipitocervical fusion.
- Author
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Wang, Lin-nan, Hu, Bo-wen, Song, Yue-ming, Liu, Li-min, Zhou, Chun-guang, Wang, Lei, and Yang, Xi
- Subjects
- *
DEGLUTITION disorders , *MEDICAL ethics committees , *MULTIPLE regression analysis , *INLETS , *VIDEOFLUOROSCOPY - Abstract
Background: PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF).Methods: Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia.Results: Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA <90° in predicting dysphagia reached 88.5%.Conclusions: PIA could be used as a predictor for postoperative dysphagia in patients undergoing OCF. Adjusting a PIA level higher than the preoperative PIA level could avoid dysphagia. For those who inevitably had decreasing PIA, preserving intraoperative PIA over 90° would help avert postoperative dysphagia.Trial Registration: This trial has been registered in the Medical Ethics Committee of West China Hospital, Sichuan University. The registration number is 762 and the date of registration is Sep. 9 th, 2019. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
18. Analysis of postoperative dysphagia after anterior cervical decompression and fusion.
- Author
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Park, Jong-Hyeok, Lee, Sun-Ho, Kim, Eun-Sang, and Eoh, Whan
- Subjects
- *
SPINAL surgery , *PREOPERATIVE risk factors , *DEGLUTITION disorders , *LAMINECTOMY , *BODY mass index , *EDEMA - Abstract
Purpose: To investigate the incidence and risk factors of postoperative dysphagia after anterior cervical decompression and fusion (ACDF) in terms of demographic, procedural and anaesthetic perspectives. Materials and methods: Medical records and radiologic data of patients who underwent anterior cervical surgery performed by two surgeons in a single centre between January 2012 and December 2015 were retrospectively analysed. Patients with spinal tumours, infective spondylitis and traumatic cervical pathologies were excluded. Patients with preoperative dysphagia and previous history of anterior cervical surgery were also excluded. Finally, 127 patients were enrolled. Bazaz dysphagia score was used for the diagnosis of postoperative dysphagia. Results: The incidence of postoperative dysphagia was 10.2% at six weeks after ACDF. Nine patients showed mild dysphagia that fully recovered at three months after ACDF. Four patients showed moderate dysphagia that also recovered fully at six months after surgery. The incidence of postoperative dysphagia increased significantly in cases of C4 or C5 level involvements. Age, sex, hypertension, body mass index, postoperative soft tissue swelling, intubation difficulty and intubation tools were not significant risk factors of ACDF. Diabetes mellitus, two surgical levels, the use of plate, long anaesthetic and operative time and large intubation tube size were causative factors of postoperative dysphagia in multivariable analysis (p < 0.05). Conclusions: The incidence of postoperative dysphagia after ACDF was relatively low, and the prognosis was good. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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19. Predictive abilities of O-C2a and O-EAa for the development of postoperative dysphagia in patients undergoing occipitocervical fusion.
- Author
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Wang, Lin-nan, Hu, Bo-wen, Song, Yue-ming, Liu, Li-min, Zhou, Chun-guang, Wang, Lei, Zhou, Zhong-jie, Xiu, Peng, Chen, Tai-yong, and Yang, Xi
- Subjects
- *
DEGLUTITION disorders , *MULTIPLE regression analysis , *SURGICAL complications - Abstract
Background Context: Dysphagia is a common postoperative complication in patients undergoing occipitocervical fusion (OCF). Previous studies had proposed the use of two measures-the occipital to C2 angle (O-C2a) and the occipital and external acoustic meatus to axis angle (O-EAa)-to predict postoperative dysphagia after OCF. However, these studies had small sample sizes and the predictive abilities of both measures are still not clear.Purpose: To evaluate the predictive ability of O-EAa and O-C2a for dysphagia after OCF.Study Design: A retrospective clinical study.Patient Sample: A total of 109 consecutive patients who had undergone OCF.Outcome Measures: Presence of postoperative dysphagia, O-C2a, C2 tilting angle (C2Ta), O-EAa, and the narrowest oropharyngeal airway space (nPAS).Methods: Between April 2010 and June 2018, 109 consecutive patients who had undergone OCF were reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic measurements, including O-C2a, C2Ta, O-EAa, and nPAS, were evaluated at preoperative and 1 month postoperative and the findings were compared. Simple linear regression was used to measure the correlations between the parameters and the presence of dysphagia, and the correlations within the parameters. Multiple regression analysis was used to examine the variables that affected the change of nPAS (dnPAS%). Sensitivity and specificity analyses were used to evaluate the effectiveness of the previously proposed measures ("O-C2a change≤-5°" and "postoperative O-EAa<100°") for prediction of post-OCF dysphagia.Results: The incidence of dysphagia after OCF was 26.6% (29/109). Preoperative values for the radiographic parameters were similar between patients with and without dysphagia. In the dysphagia group, both O-C2a and O-EAa values showed a dramatic decrease after surgery, which was accompanied by a decrease in nPAS. Postoperative O-C2a, O-EAa, and nPAS in the dysphagia group were significantly smaller than those in the nondysphagia group (p<.05). The changes in O-EAa, O-C2a, and nPAS showed a linear correlation with the presence of dysphagia (p<.05). In addition, linear correlations were found between two of the three parameters. Multiple regression showed the change of O-C2a and O-EAa were significant predictors for dnPAS% (β=0.200, p=.022 and β=0.549, p=.000). The sensitivity and specificity of "O-C2a change≤-5°" in predicting dysphagia were 75.9% and 80.0% respectively, and those of "postoperative O-EAa<100°" were 75.9% and 62.5%, respectively. However, the sensitivity of the combination of these two values in predicting postoperative dysphagia was as high as 96.6%.Conclusion: Both O-EAa and O-C2a could be critical predictors for postoperative dysphagia. During surgery, ensuring that the O-EAa exceeds 100° and simultaneously avoiding an O-C2a reduction greater than 5° could effectively avert postoperative dysphagia. [ABSTRACT FROM AUTHOR]- Published
- 2020
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20. Comparison between anterior cervical discectomy and fusion using Zero-P and traditional anterior cervical plate plus cage for treating two-level cervical spondylosis.
- Author
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Yu Bin, Peng Yinxlao, Xue Li, Qln Hui, and Liang Yijlan
- Subjects
- *
SPONDYLOSIS , *ESOPHAGEAL fistula , *DISCECTOMY , *INFORMED consent (Medical law) , *INTERVERTEBRAL disk , *RHINORRHEA - Abstract
BACKGROUND: Anterior cervical discectomy and fusion is a classic surgical procedure for the treatment of cervical spondylosis. At present, we can use a Zero-P lnterbody fusion fixture and a traditional cervical anterior plate plus cage as an internal fixation material. The Zero-P has less postoperative esophageal interference and lower incidence of postoperative dysphagia compared with traditional anterior cervical plate fixation. Besides, the Zero-P could avoid the risk of excessively long or poorly placed plate Injury to adjacent segmental Intervertebral discs. OBJECTIVE: To compare the safety and effectiveness between two-level anterior cervical discectomy and fusion using Zero-P and using traditional anterior cervical plate plus cage. METHODS: Clinical data of sixty patients who underwent two-level anterior cervical discectomy and fusion in the Chengdu Third People's Hospital from May 2016 to May 2018 were retrospectively analyzed. The patients were divided into Zero-P group (Zero-P fusion, n=30) and plate group (anterior cervical plate fixation combined with cage Implantation, n=30). All patients In the two groups had Informed consent to the treatment plan. This study was approved by the hospital ethics committee. The Japanese orthopedic association score, neck disability index score and Bazaz swallowing function score ware used to evaluate the clinical efficacy. Cervical X-ray and cervical CT scans were performed to assess cervical curvature, observe bone graft fusion, and implant displacement, loosening and breakage. RESULTS AND CONCLUSION: (1) All surgeries were successfully completed in 60 patients. The wounds healed In stage I after operation. There were no serious complications such as nerve injury, esophageal fistula, and cerebrospinal fluid leakage. (2) During the follow-up, there was no significant difference in neck disability index, Japanese orthopedic association score and bone graft fusion rates between the two groups (P > 0.05). (3) The incidence and severity of dysphagia in the Zero-P group were lower than those in the plate group at various time points after operation (all P < 0.05). (4) The overall curvature and operative segments curvature ware better in the plate group than in the Zero-P group 6 months after surgery and in final follow-up (P < 0.05). (5) Two-level anterior cervical dlscectomy and fusion using Zero-P Is a safe and effective operative method. The operation time, bleeding volume, number of fluoroscopy and postoperative dysphagia incidence were better than the traditional anterior cervical plate plus cage fixation system, but It Is not as good as the traditional anterior cervical plate plus cage system in the curvature of the cervical spine. Zero-P is not recommended for patients with obvious abnormal cervical curvature before operation. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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21. Electrical lower esophageal sphincter augmentation in patients with GERD and severe ineffective esophageal motility-a safety and efficacy study.
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Paireder, Matthias, Kristo, Ivan, Asari, Reza, Jomrich, Gerd, Steindl, Johanns, Rieder, Erwin, and Schoppmann, Sebastian F.
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- *
ESOPHAGEAL motility , *ESOPHAGOGASTRIC junction , *QUALITY of life - Abstract
Background: Laparoscopic fundoplication (LF), even if performed in specialized centers, can be followed by long-term side effects such as dysphagia, gas bloating or inability to belch. Patients with an ineffective esophageal motility (IEM) and concurrent GERD are prone to postoperative dysphagia after LF. The aim of this study is to evaluate the safety and efficacy of electrical lower esophageal sphincter stimulation in patients with IEM and GERD.Methods: This is a prospective, open-label single center study. Patients with PPI-refractory GERD and ineffective esophageal motility were included for lower esophageal sphincter electrical stimulation (LES-EST). Patients underwent prospective follow-up including physical examination, interrogation of the device and were surveyed for changes in the health-related quality of life score.Results: According to power analysis, 17 patients were included in this study. Median distal contractile integral (DCI) was 64 mmHg s cm (quartiles 11.5-301). Median total % pH < 4 was 8.9 (quartiles 4-21.6). Twelve patients (70.6%) underwent additional hiatal repair. At 1-month follow-up, none of the patients showed any clinical or radiological signs of dysphagia. There were no procedure related severe adverse events. Mean total HQRL improved from baseline 37.53 (SD 15.07) to 10.93 (SD 9.18) at follow-up (FUP) (mean difference 24.0 CI 15.93-32.07) p < 0.001.Conclusions: LES-EST was introduced as a potential technique to avoid side effects of LF. LES-EST significantly improved health related quality of life and does not impair swallowing in patients with GERD and ineffective esophageal motility. [ABSTRACT FROM AUTHOR]- Published
- 2019
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22. Complication in Laparoscopic GERD: A Guide to Prevention and Management
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Avci, Cavit, Avci, Cavit, editor, and Schiappa, José M., editor
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- 2016
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23. Poor Esophageal Motility: A Tailored Approach?
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Niebisch, Stefan, Peters, Jeffrey H., Swanstrom, Lee L., editor, and Dunst, Christy M., editor
- Published
- 2015
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24. [Introduction of fiberoptic endoscopic evaluation of swallowing and increase of the range of indications in our department].
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Ambrus A, Rovó L, Sztanó B, Burián A, Molnár-Tóth A, and Bach Á
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- Humans, Deglutition, Endoscopy methods, Deglutition Disorders etiology, Head and Neck Neoplasms, Nervous System Diseases
- Abstract
Dysphagia is a disease resulting from preparatory or transport disorder of the swallowing process and it is divided into oropharyngeal and esophageal phases according to the site of the lesion. The ear, nose and throat assessment focuses on the oropharyngeal phase, but differential diagnosis, investigation, and treatment of the cause of dysphagia is often a complex task requiring multidisciplinary approach and collaboration. The method of fiberoptic endoscopic evaluation of swallowing (FEES) has been introduced at the Department of Ear, Nose and Throat and Head-Neck Surgery, University of Szeged, enabling the examination of otorhinolaryngological and neurological disorders of swallowing as well as objective analysis of patients' swallowing quality. The fiberoptic endoscopic evaluation of swallowing is a minimally invasive procedure that allows visualization of the oropharyngeal phase of swallowing. It can identify anatomical abnormalities or neurological disorders causing dysphagia, thus playing a significant role in later patient rehabilitation. We hereby present our experiences in examinations of patients who underwent partial laryngectomy and/or pharyngectomy due to head and neck tumors as well as of those who underwent airway surgery duo to upper airway stenosis. Thanks to our collaboration with the Neurology Department, we also share our experiences gained during the examinations of patients struggling with oropharyngeal swallowing problems of various neurological origins. Orv Hetil. 2023; 164(46): 1817-1823.
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- 2023
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25. Development and Validation of a Predictive Model to Evaluate the Risk of Dysphagia Following Anterior Cervical Discectomy and Fusion.
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Luan H, Liu X, Liu K, Song J, Peng C, Sheng W, and Deng Q
- Abstract
Study Design: A retrospective study., Objective: To investigate the potential risk factors of dysphagia after anterior cervical discectomy and fusion (ACDF) and to establish and validate a prediction model., Methods: The clinical data of 252 patients who underwent anterior cervical discectomy and fusion in our hospital from January 2018 to October 2020 were retrospectively analyzed and divided into the dysphagia group and the non-dysphagia group according to whether dysphagia occurred after surgery. Age, gender, body mass index, smoking and drinking history, hypertension history, diabetes history, disease duration, placement of Hemovac negative pressure drain, number of segments involved in surgery, whether C
4-5 /C5-6 segment surgery, incision length, incision position, level of preoperative EAT-10 score, whether preoperative tracheal exercise, and changes in cervical curvature before and after surgery were recorded in both groups. Risk factors for postoperative dysphagia were identified and nomogram prediction models were developed., Results: A total of 252 patients were included in the study, 115 of whom presented with dysphagia within 1 week after anterior cervical fusion. The results of multivariate logistic regression analysis indicated that male gender (OR = .045, 95% CI .223-.889) and whether preoperative tracheal exercise (OR = .260, 95% CI .107-.633) were independent risk factors associated with reduced incidence of postoperative dysphagia., Conclusion: The incidence of dysphagia symptoms after anterior cervical decompression and fusion gradually decreased with the extension of follow-up time, and preoperative tracheal exercise and shortening the operation time may help to reduce the occurrence of postoperative dysphagia., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.- Published
- 2023
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26. Laparoscopic Nissen Fundoplication
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Scott-Conner, Carol E. H. and Scott-Conner, Carol E.H., editor
- Published
- 2014
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27. Persistent Dysphagia Rate After Antireflux Surgery is Similar for Nissen Fundoplication and Partial Fundoplication.
- Author
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Walle, Kara Vande, Funk, Luke M., Xu, Yiwei, Davies, Kevin D., Greenberg, Jacob, Shada, Amber, and Lidor, Anne
- Subjects
- *
FUNDOPLICATION , *GASTROESOPHAGEAL reflux , *DEGLUTITION disorders , *SURGICAL complications , *DISEASE risk factors - Abstract
Abstract Background Laparoscopic fundoplication is the gold standard operation for treatment of gastroesophageal reflux disease (GERD). It has been suggested that persistent postoperative dysphagia is increased following Nissen fundoplication compared to partial fundoplication. This study aimed to determine risk factors for persistent postoperative dysphagia, specifically examining the type of fundoplication. Methods Patients experiencing GERD symptoms who underwent laparoscopic Nissen, Toupet, or Dor fundoplication from 2009 to 2016 were identified from a single-institutional database. A dysphagia score was obtained as part of the GERD health-related quality of life questionnaire. Persistent dysphagia was defined as a difficulty swallowing score ≥1 (noticeable) on a scale from 0 to 5 at least 1 y postoperatively. Odds ratios of persistent dysphagia among those who underwent antireflux surgery were calculated in a multivariate logistic regression model adjusted for fundoplication type, sex, age, body mass index, and redo operation. Results Of the 441 patients who met inclusion criteria, 255 had ≥1 y of follow-up (57.8%). The median duration of follow-up was 3 y. In this cohort, 45.1% of patients underwent Nissen fundoplication and 54.9% underwent partial fundoplication. Persistent postoperative dysphagia was present in 25.9% (n = 66) of patients. On adjusted analysis, there was no statistically significant association between the type of fundoplication (Nissen versus partial) and the likelihood of postoperative dysphagia. Conclusions Persistent postoperative dysphagia after antireflux surgery occurred in approximately one-quarter of patients and did not differ by the type of fundoplication. These findings suggest that both Nissen and partial fundoplication are reasonable choices for an antireflux operation for properly selected patients. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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28. Postoperative Dysphagia After Anterior Cervical Spinal Surgery
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Tyler J. Jenkins, Peter F. Helvie, Alpesh A. Patel, and Brett D. Rosenthal
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medicine.medical_specialty ,Postoperative dysphagia ,business.industry ,medicine ,General Earth and Planetary Sciences ,General Medicine ,business ,Spinal surgery ,Surgery ,General Environmental Science - Published
- 2022
29. Anti-Reflux Surgery
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Wilshire, Candice L., Peters, Jeffrey H., Shaker, Reza, editor, Belafsky, Peter C., editor, Postma, Gregory N., editor, and Easterling, Caryn, editor
- Published
- 2013
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30. The Effect of Esophageal Temperature Probes on Postoperative Dysphagia Following Primary Anterior Cervical Discectomy and Fusion: A Randomized Prospective Study
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Matthew Cyriac, Daniel Huttman, Jeffrey H. Weinreb, Rahul G. Samtani, Joseph R. O'Brien, and Warren D. Yu
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medicine.medical_specialty ,Esophageal temperature ,business.industry ,Cervical Spine ,Anterior cervical discectomy and fusion ,Dysphagia ,Surgery ,law.invention ,Postoperative dysphagia ,Randomized controlled trial ,law ,medicine ,Orthopedics and Sports Medicine ,Clinical significance ,Anterior approach ,medicine.symptom ,business ,Prospective cohort study - Abstract
Background: The anterior approach to the cervical spine is associated with postoperative dysphagia. It is difficult to predict which patients are most at risk for dysphagia. The objective of this study was to determine if placing an esophageal temperature probe preoperatively would affect the severity and length of postoperative dysphagia. We hypothesize that use of an esophageal temperature probe would result in worse postoperative dysphagia at all measured time points as measured by the Swallowing-Quality of Life (SQAL-QOL) survey after anterior cervical discectomy and fusion (ACDF). Methods: A total of 44 patients were enrolled in a prospective, randomized controlled trial and randomized into groups: 1 with an esophageal temperature probe placed at the time of surgery and 2 without. A total of 39 patients filled out postoperative SWAL-QOL questionnaires at their preoperatives. Using the survey results, the data were analyzed between groups and subanalyzed based on number of operative levels and sex. Results: SWAL-QOL scores for patients undergoing 2-level ACDF with an esophageal temperature probe were significantly better compared with those without a probe at 2 weeks and 6 months postoperatively. These results were not significant at other time points in in the overall analysis, but a trend toward improved dysphagia scores at each time point postoperatively was seen with the probe group. No differences were found between the 2 groups with respect to age at the time of surgery, sex, and preoperative SWAL-QOL score. Conclusions: Placement of an esophageal temperature probe at the time of surgery significantly improved postoperative dysphagia scores in patients undergoing 2-level ACDF at 2 weeks and 6 months postoperatively. Level of Evidence: 2 Clinical Relevance: Placement of a temperature probe is a safe and effective technique that is readily available and easily applicable to the practice of spine surgery and may improve postoperative dysphagia after ACDF.
- Published
- 2021
31. Partial or Total Fundoplication for GERD in the Presence of Impaired Esophageal Motility
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Watson, David I. and Ferguson, Mark K., editor
- Published
- 2011
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32. Development of predictive score for postoperative dysphagia after emergency abdominal surgery in patients of advanced age.
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Iguchi T, Mita J, Iseda N, Sasaki S, Harada N, Ninomiya M, Sugimachi K, Honboh T, Sadanaga N, and Matsuura H
- Abstract
Aim: Postoperative dysphagia after emergency abdominal surgery (EAS) in patients of advanced age has become problematic, and appropriate dysphagia management is needed. This study was performed to identify predictive factors of dysphagia after EAS and to explore the usefulness of swallowing screening tools (SSTs)., Methods: This retrospective study included 267 patients of advanced age who underwent EAS from 2012 to 2022. They were assigned to a dysphagia group and non-dysphagia group using the Food Intake Level Scale (FILS) (dysphagia was defined as a FILS level of <7 on postoperative day 10). From 2018, original SSTs including a modified water swallowing test were performed by nurses., Results: The incidence of postoperative dysphagia was 22.8% (61/267). Patients were significantly older in the dysphagia than non-dysphagia group. The proportions of patients who had poor nutrition, cerebrovascular disorder, Parkinson's disease, dementia, nursing-care service, high intramuscular adipose tissue content (IMAC), and postoperative ventilator management were much higher in the dysphagia than non-dysphagia group. Using logistic regression analysis, high IMAC, postoperative ventilator management, cerebrovascular disorder, and dementia were correlated with postoperative dysphagia and were assigned 10, 4, 3, and 3 points, respectively, according to each odds ratio. The optimal cut-off value was 7 according to a receiver operating characteristics curve. Using 1:1 propensity score matching for high-risk patients, the incidence of postoperative dysphagia was reduced by SSTs., Conclusions: The new prediction score obtained from this study can identify older patients at high risk for dysphagia after EAS, and SSTs may improve these patients' short-term outcomes., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.)
- Published
- 2023
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33. Partial or Complete Fundoplication for Gastroesophageal Reflux Disease
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Simons, Christopher M., Duppler, David, Cook, Michael, Richardson, William, and Scott-Conner, Carol E. H., editor
- Published
- 2008
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34. Dysphagia Severity and Outcomes Following Iatrogenic High Vagal Nerve Injury
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Alfred A. Simental, Priya D. Krishna, Ethan R. Miles, Paul C. Walker, Jared C. Inman, Brianna K. Crawley, and Steve C. Lee
- Subjects
business.industry ,Medialization Laryngoplasty ,Vagal nerve ,Iatrogenic Disease ,General Medicine ,Enteral administration ,Dysphagia ,Laryngoplasty ,Treatment Outcome ,Otorhinolaryngology ,Postoperative dysphagia ,Swallowing ,Anesthesia ,otorhinolaryngologic diseases ,Humans ,Referral center ,Medicine ,Cricopharyngeal myotomy ,medicine.symptom ,Deglutition Disorders ,business ,Retrospective Studies - Abstract
Objective: To examine severity of dysphagia and outcomes following iatrogenic high vagal nerve injury. Methods: Retrospective chart review of all patients with iatrogenic high vagal nerve injury that were seen at a tertiary referral center from 2012 to 2020. Results: Of 1304 patients who met criteria for initial screening, 18 met all inclusion criteria. All 18 required intervention to address postoperative dysphagia. Eleven required enteral feeding tubes with 7 eventually able to advance to exclusively per oral diets. Fourteen underwent vocal fold injection and 6 underwent laryngeal framework surgery. Sixteen pursued swallowing therapy with speech language pathology. Patients lost a mean of 8.6 kg of weight in the 6 months following the injury. Swallowing function on the Functional Outcome Swallowing Scale (FOSS) and Functional Oral Intake Scale (FOIS) was 4.4 and 2.4 respectively immediately following the injury and improved to 1.9 and 5.3 at the last follow-up. No patients had complete return of normal swallowing function at last follow up. Conclusion: Iatrogenic high vagal injury causes significant lasting dysphagia which improves with intervention but does not completely resolve. Interventions such as vocal fold injection, medialization laryngoplasty, cricopharyngeal myotomy, or swallowing therapy may be required to reestablish safe swallowing in these patients.
- Published
- 2021
35. Incidence and Risk Factors of Postoperative Dysphagia in Severe Aortic Stenosis
- Author
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Takuya Nakamura, Shogo Fukui, Sho Takeuchi, Keiichi Fukuda, Fumio Liu, Meigen Liu, Michiyuki Kawakami, Kentaro Hayashida, Shinji Kawaguchi, Hideyuki Shimizu, and Tetsuya Tsuji
- Subjects
medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Rehabilitation ,Physical Therapy, Sports Therapy and Rehabilitation ,Perioperative ,medicine.disease ,Dysphagia ,Surgery ,Pneumonia ,Stenosis ,Postoperative dysphagia ,Aortic valve stenosis ,Medicine ,Geriatrics and Gerontology ,medicine.symptom ,business - Published
- 2021
36. Operation for GERD: Conventional Approach
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Gawad, Karim A., Busch, Christoph, Clavien, Pierre-Alain, editor, Sarr, Michael G., editor, Fong, Yuman, editor, and Georgiev, Panco, editor
- Published
- 2007
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37. Laparoscopic Toupet Fundoplication
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Zornig, C., Granderath, Frank A., editor, Kamolz, Thomas, editor, and Pointner, Rudolph, editor
- Published
- 2006
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38. Laparoscopic Nissen Fundoplication
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Scott-Conner, Carol E. H., editor
- Published
- 2006
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39. Postoperative Dysphagia Following Esophagogastric Fundoplication: Does the Timing to First Dilation Matter?
- Author
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Dimitrios Stefanidis, Jennifer N. Choi, Don J. Selzer, Dimitrios I. Athanasiadis, and Ambar Banerjee
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Reflux ,Recurrent reflux ,Hernia repair ,Dysphagia ,Surgery ,03 medical and health sciences ,Dilation (metric space) ,0302 clinical medicine ,Postoperative dysphagia ,Patient age ,030220 oncology & carcinogenesis ,otorhinolaryngologic diseases ,medicine ,030211 gastroenterology & hepatology ,In patient ,medicine.symptom ,business - Abstract
Postoperative dysphagia after anti-reflux surgery typically resolves in a few weeks. However, even after the initial swelling has resolved at 6 weeks, dysphagia can persist in 30% of patients necessitating esophageal dilation. The purpose of this study was to investigate the effect of esophageal dilation on postoperative dysphagia, the recurrence of reflux symptoms, and the efficacy of pneumatic dilations on postoperative dysphagia. A prospectively collected database was reviewed for patients who underwent partial/complete fundoplication with/without paraesophageal hernia repair between 2006 and 2014. Patient age, sex, BMI, DeMeester score, procedure type, procedure duration, length of stay, postoperative dysphagia, time to first pneumatic dilation, number of dilations, and the need for reoperations were collected. The study included 902 consecutive patients, 71.3% females, with a mean age of 57.8 ± 14.7 years. Postoperative dysphagia was noted in 26.3% of patients, of whom 89% had complete fundoplication (p < 0.01). Endoscopic dilation was performed in 93 patients (10.3%) with 59 (63.4%) demonstrating persistent dysphagia. Recurrent reflux symptoms occurred in 35 (37.6%) patients who underwent endoscopic dilation. Patients who underwent a dilation for symptoms of dysphagia were less likely to require a revisional surgery later than patients who had dysphagia but did not undergo a dilation before revisional surgery (17.2% vs 41.7%, respectively, p < 0.001) in the 4-year follow-up period. The duration of initial dilation from surgery was inversely related to the need for revisional surgery (p = 0.047), while more than one dilation was not associated with additive benefit. One attempt at endoscopic dilation of the esophagogastric fundoplication may provide relief in patients with postoperative dysphagia and can be used as a predictive factor for the need of revision. However, there is an increased risk for recurrent reflux symptoms and revisional surgery may ultimately be indicated for control of symptoms.
- Published
- 2021
40. Efficacy evaluation of pepsin in laparoscopic antireflux surgery for gastroesophageal reflux disease
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Xiang Gao, Fei Li, Zhonggao Wang, Diangang Liu, Ji-Min Wu, Feng Wang, Xing Du, and Chao Zhang
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Male ,medicine.medical_specialty ,Biomedical Engineering ,Biophysics ,Fundoplication ,Health Informatics ,Bioengineering ,Disease ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,Pepsin ,medicine ,Humans ,Laparoscopy ,Aged ,Hiatal hernia repair ,Antireflux surgery ,medicine.diagnostic_test ,biology ,business.industry ,Reflux ,Middle Aged ,medicine.disease ,Pepsin A ,digestive system diseases ,Surgery ,Treatment Outcome ,Postoperative dysphagia ,030220 oncology & carcinogenesis ,Gastroesophageal Reflux ,GERD ,biology.protein ,Female ,030211 gastroenterology & hepatology ,business ,Information Systems - Abstract
BACKGROUND: The false positive rate of the PPI test for the diagnosis of typical symptoms of gastroesophageal reflux disease (GERD) is extremely high. OBJECTIVE: This study aims to investigate the effect of the pepsin test on GERD and laparoscopy-assisted anti-reflux surgery for GERD. METHODS: A total of 30 GERD patients were enrolled into this study, and the pre-diagnosis of GERD was determined by symptom evaluation, impedance-pH examination, gastroscopy and pepsin test. All patients underwent surgery. RESULTS: Among the 30 GERD patients, 18 patients were male and 12 were female, and their average age was 58.2 + 12.6 years old. The patients were treated with laparoscopic fundoplication and hiatus hernia repair after preoperative assessment. A total of 28 patients were followed up, one patient developed recurrent symptoms, and one patient developed postoperative dysphagia and received non-operative treatment. Furthermore, the symptom scores were significantly lower at postoperative pepsin detection when compared to the scores before the operation (pepsin: preoperative: 148.8 ± 82.6, postoperative: 30.7 ± 24.6; t= 4.848, P= 0.000). CONCLUSIONS: Laparoscopic fundoplication and hiatus hernia repair may effectively control the symptoms of GERD. Furthermore, the detection of pepsin is non-invasive and easy to operate.
- Published
- 2021
41. Laparoscopic Nissen Fundoplication
- Author
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Scott-Conner, Carol E. H. and Scott-Conner, Carol E. H.
- Published
- 2002
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42. THE EFFECTIVENESS OF MESH REINFORCEMENT DURING LAPAROSCOPIC HIATAL HERNIA REPAIR
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medicine.medical_specialty ,Mesh repair ,business.industry ,Reflux ,medicine.disease ,Surgery ,Hiatal hernia ,03 medical and health sciences ,0302 clinical medicine ,Suture (anatomy) ,Postoperative dysphagia ,030220 oncology & carcinogenesis ,Medicine ,030211 gastroenterology & hepatology ,Hernia ,business ,Mesh reinforcement ,Surgical treatment - Abstract
Purpose . To analyze short-term and long-term results of surgical treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease. Materials and methods . A retrospective analysis of short-term and long-term results of treatment of 98 patients for the period 2009–2016, who underwented surgical treatment of hiatal hernia with a hernia defect size 5 or more cm was performed. The first group included 69 patients underwent suture repair of hernia defect. The second group underwent mesh repair - 29 patients. Results . Intraoperative complications - 7 (10.1%) versus 2 (6.9%), postoperative complications - 6 (8.7%) versus 3 (10.4%), the duration of surgery - 141 ± 21.1 min versus 179 ± 28.4, duration of hospital stay - 6.7 ± 1.6 days versus 6.9 ± 1.8, postoperative dysphagia - 11 (15.9%) versus 6 (20.7%) were not noted. In 5 years after surgery, reccurence in the suture group were noted in 14 (20.3%) patients, in the mesh group - in 4 (13.8%) patients. The total GERD–HRQL questionnaire score was 6.4 ± 1.8 points in the suture repair group and 5.9 ± 2.1 points in the mesh group. 9 (13%) patients in the suture repair group and 5 (17.2%) in the mesh group evaluated their condition as unsatisfactorily. Conclusion . The analysis of long-term results in 5 years after the surgery showed the absence of benefit after using mesh reinforcement during laparoscopic repair of large hiatal hernias compared to usual suture cruroraphy both in recurrence rate and in assessing the quality of life.
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- 2020
43. Hyoid position as a novel predictive marker for postoperative dysphagia and dysphonia after anterior cervical discectomy and fusion
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Andrew A. Sama, Alexander P. Hughes, Stephan N. Salzmann, Erika Chiapparelli, Federico P. Girardi, Yushi Hoshino, Jennifer Shue, Ichiro Okano, Frank P. Cammisa, and Courtney Ortiz Miller
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030222 orthopedics ,medicine.medical_specialty ,Univariate analysis ,Predictive marker ,business.industry ,Radiography ,Anterior cervical discectomy and fusion ,Retrospective cohort study ,Dysphagia ,03 medical and health sciences ,0302 clinical medicine ,Postoperative dysphagia ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Radiology ,Neurosurgery ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
The purpose of this study is to investigate the predictive value of the hyoid horizontal positional change on the severity of dysphagia and dysphonia (PDD) after anterior cervical discectomy and fusion (ACDF) comparing pre-vertebral soft-tissue thickness (PVST). This is a retrospective observational study with prospectively collected data at a single academic institution. ACDF patients between 2015 to 2018 who had complete self-reported PDD surveys and pre- and postoperative lateral cervical radiographs were included in the analysis. PDD was assessed utilizing the Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI). The hyoid-vertebral distance (HVD) and PVST (the averages of C2 to C7 levels (PVSTC2–7) and all operating levels (PVSTOP)) were assessed preoperatively and upon discharge. The associations among postoperative changes of HVD, PVSTs, and the 4-week HSS-DDI score were evaluated. Of the 268 patients with a HSS-DDI score assessment, 209 patients had complete data. In univariate analyses, HVD and PVSTC2–7 changes demonstrated significant correlations with HSS-DDI, whereas PVSTOP showed no significant association. After adjusting with sex and operating level, the changes in HVD (p = 0.019) and PVSTC2–7 (p = 0.009) showed significant associations with the HSS-DDI score and PVSTOP showed no significant association. PVSTC2-7 could not be evaluated in 12% of patients due to measurement difficulties of PVST at lower levels. We introduce a novel potential predictive marker for PDD after ACDF. Our results suggest that HVD can be utilized for the risk assessment of PDD, especially in PVST unmeasurable cases, which accounts for over 10% of ACDF patients.
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- 2020
44. Application of Zero-profile Spacer in the Treatment of Three-level Cervical Spondylotic Myelopathy
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Huiqiao Wu, Wenbo Lin, Xiaodong Wu, Shi Changgui, Bin Sun, Xiaolong Shen, Zeng Xu, Ying Zhang, and Wen Yuan
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,5 year follow up ,Anterior cervical discectomy and fusion ,Spinal Cord Diseases ,Three level ,03 medical and health sciences ,0302 clinical medicine ,Spondylotic myelopathy ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,030222 orthopedics ,Cobb angle ,business.industry ,Retrospective cohort study ,Middle Aged ,Surgery ,Spinal Fusion ,Treatment Outcome ,Postoperative dysphagia ,Cervical Vertebrae ,Female ,Spondylosis ,Neurology (clinical) ,Fusion rate ,business ,Bone Plates ,030217 neurology & neurosurgery ,Diskectomy ,Follow-Up Studies - Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To assess the long-term results of zero-profile spacer for 3-level anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Although widely used, there are still controversies about the long-term results of zero-profile spacer, especially in multilevel cases. METHODS Cases received 3-level ACDF for cervical spondylotic myelopathy (CSM) using either zero-profile spacer (n = 27) (ZP Group), or plate and cages (n = 34) (PC Group), and with 5-year follow-up were reviewed. Neurological function and life quality were assessed by modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and Short-Form 36 (SF-36) score. Disc height, cervical lordosis, fusion rate, and surgical complications were observed. RESULTS Neurological recovery and life quality improvement were similar in both groups. Disc height and cervical lordosis (C2-7 Cobb angle) were well restored after operations, but lost in both groups during follow-up. Loss of correction (LOC) in disc height was larger in ZP Group (11.38% vs 5.71%, P
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- 2020
45. Postoperative Dysphagia Following Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease
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Ulf Kessler, Joerg Zehetner, Catherine Tsai, Hans Merki, Rudolf Steffen, and John C. Lipham
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Magnetic Field Therapy ,medicine.medical_treatment ,Disease ,Nissen fundoplication ,Esophageal Sphincter, Lower ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,Medical record ,Reflux ,Middle Aged ,medicine.disease ,Dysphagia ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Postoperative dysphagia ,030220 oncology & carcinogenesis ,Gastroesophageal Reflux ,Quality of Life ,GERD ,Sphincter ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,medicine.symptom ,Deglutition Disorders ,business - Abstract
The addition of posterior cruroplasty to magnetic sphincter augmentation (MSA-PC) has been shown to be effective in treating gastroesophageal reflux disease (GERD). This study evaluates the predictors of persistent postoperative dysphagia, one of the major complaints after MSA-PC. From August 2015 to February 2018 the medical records of 118 patients (male=59, female=59) receiving MSA-PC for GERD were reviewed. Postoperative dysphagia was present in 80 patients (67.8%), with 20 (16.9%) requiring dilation for persistent dysphagia. Three patients (2.5%) had the magnetic sphincter augmentation device removed for persistent dysphagia, one was converted to a Nissen fundoplication. The median number of dilations was 1, mean time from surgery to dilation was 5.6 months, and 15/20 (75%) had symptom resolution after 1 to 2 dilations. Dilated patients were more likely than nondilated patients to have atypical GERD symptoms preoperatively (70% vs. 44.7%, P=0.042). After dilation, 93.3% of patients reported a good quality of life.
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- 2020
46. Role of preoperative cervical alignment on postoperative dysphagia after occipitocervical fusion
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Satoru Ebihara, Hideki Sekiya, Hiroshi Takahashi, and Midori Miyagi
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medicine.medical_specialty ,Radiography ,Occipitocervical fusion ,03 medical and health sciences ,0302 clinical medicine ,Swallowing ,Preoperative cervical alignment ,otorhinolaryngologic diseases ,Medicine ,In patient ,030212 general & internal medicine ,business.industry ,Incidence (epidemiology) ,Dysphagia ,The functional oral intake scale ,Surgery ,Deglutition ,Postoperative dysphagia ,Original Article ,Neurology (clinical) ,medicine.symptom ,Airway ,business ,030217 neurology & neurosurgery - Abstract
Background: Dysphagia is one of the most serious complications of occipitocervical fusion (OCF). The previous studies have shown that postoperative cervical alignment, documented with occipito (O)-C2 angles, C2-C6 angles, and pharyngeal inlet angles (PIA), impacted the incidence of postoperative dysphagia in patients undergoing OCF. Here, we investigated the relationship of preoperative versus postoperative cervical alignment on the incidence of postoperative dysphagia after OCF. Methods: We retrospectively reviewed the clinical data/medical charts for 22 patients following OCF (2006– 2019). The O-C2 angles, C2-C6 angles, PIA, and narrowest pharyngeal airway spaces (nPAS) were assessed using plain lateral radiographs of the cervical spine before and after the surgery. The severity of dysphagia was assessed with the functional oral intake scale (FOIS) levels as documented in medical charts; based on this, patients were classified into the nondysphagia (FOIS: 7) versus dysphagia (FOIS: 1–6) groups. Results: Seven patients (35%) experienced dysphagia after OCF surgery. Preoperative PIA and nPAS were smaller in the dysphagia group. Spearman rank correlation showed a positive correlation between preoperative PIA and FOIS and between preoperative nPAS and FOIS. Conclusion: This study suggests that preoperative cervical alignment may best predict the incidence of postoperative dysphagia after OCF.
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- 2021
47. A Continuous 10-Year Assessment of the Results of Surgery for Shortened Esophagus
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Jeyasingham, K., Bhatnagar, N. K., Peppas, G., Payne, H. R., Nabeya, Kin-ichi, editor, Hanaoka, Tateo, editor, and Nogami, Hiroshi, editor
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- 1993
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48. Esophageal Calibration with Soft Orogasrtric Tube During Laparoscopic Nissen Fundoplication may Reduce Postoperative Transient Dysphagia.
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Bülbüller, Nurullah and Oner, Osman
- Abstract
Gastroesophageal reflux is the most common benign disorder of the esophagus and laparoscopic Nissen fundoplication has become the standard surgical treatment for its treatment. In our area, where the use of bougie calibration is debatable, postoperative dysphagia is encountered often after this surgery although it is usually not permanent. The aim of this study was to investigate the effect of using a soft silicone tube 39 F in diameter for esophageal calibration during laparoscopic Nissen fundoplication on the incidence of postoperative dysphagia. We divided cases scheduled to undergo laparoscopic Nissen fundoplication between January 2009 and November 2010 into two groups, each consisting 25 patients. Esophageal calibration with a 39 F silicone orogastric tube was used for the first group while there was no operative calibration in the second group. The surgical duration was recorded; the presence and severity of the postoperative dysphagia was calculated by using a dysphagia severity scoring system during the 1-year postoperative follow-up. The dysphagia severity scores were significantly lower in group 1 than group 2 on the postoperative second day and at the end of the first week and first month. We did not find a significant difference at the end of the 6-month and first year. There was also no significant difference regarding surgery duration. The use of a soft orogastric tube 39 F in diameter for esophagus calibration during laparoscopic Nissen fundoplication has significantly decreased the incidence of postoperative transient dysphagia without affecting the duration of surgery. Although dysphagia gradually resolves in the majority of patients, a safe and easy calibration method for its prevention is worth developing, and we believe that the use of our method in larger series could be beneficial. [ABSTRACT FROM AUTHOR]
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- 2015
- Full Text
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49. Balloon up or balloon away? Examining the management of postoperative dysphagia following fundoplication
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John E. Pandolfino, Marianna Papademetriou, and John Damianos
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medicine.medical_specialty ,business.industry ,Reflux ,Balloon ,medicine.disease ,Dysphagia ,Surgery ,Clinical trial ,Postoperative dysphagia ,medicine ,GERD ,In patient ,medicine.symptom ,business ,High resolution manometry - Abstract
Dysphagia following laparoscopic fundoplication for medically refractory gastroesophageal reflux disease (GERD) is common. In patients without an anatomic defect, it has been hypothesized that the ant reflux wrap may be too tight. Therefore, pneumatic dilation may help relieve the obstruction. While retrospective data support this hypothesis, prospective data are lacking. We summarize the @GIJournal discussion held on February 17, 2021, during which the article by Schuitenmaker et al. “Pneumatic dilation for persistent dysphagia after ant reflux surgery, a multicentre single-blind randomized sham-controlled clinical trial” was critically reviewed by our expert Dr. John Pandolfino (JP), and moderated by Dr. Marianna Papademetriou (MP).
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- 2021
50. POSTOPERATIVE DYSPHAGIA AFTER LAPAROSCOPIC FUNDOPLICATION AS A TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE
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T Diaz Vico, G Martínez Izquierdo, E Turienzo Santos, P del Val Ruiz, L Sanz Álvarez, S Amoza Pais, M Moreno Gijón, and B Carrasco Aguilera
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medicine.medical_specialty ,business.industry ,Treatment outcome ,Reflux ,Disease ,medicine.disease ,Comorbidity ,Surgery ,Postoperative dysphagia ,Quality of life ,Barrett's esophagus ,medicine ,business - Abstract
INTRODUCTION Laparoscopic Fundoplication (LF) as a treatment for gastroesophageal reflux disease (GERD) has positive clinical outcomes. However, postoperative dysphagia (PD) may appear as a side effect. Our objective is to analyze PD in patients operated on for LF in our center. MATERIAL AND METHODS Retrospective and descriptive study of patients operated on for GERD from September 1997 to February 2019. RESULTS 248 patients (60.5% men), with a mean age of 49.7 (21-82), were operated. 66.1% of the patients presented associated comorbidities, highlighting obesity (19.8%). 75% manifested typical symptoms, 19% presenting with Barrett’s esophagus. Sliding hiatal, paraesophageal, mixed and complex hernia were diagnosed in 151 (60.9%), 23 (9.3%), 12 (4.8%), and 4 (1.6%) patients, respectively. The LF Nissen was the most frequent technique (91.5%), using a caliper in 46% of the cases. PD was the most frequent symptom, present in 57 (23%) patients. It was resolved with dilation in 9 patients, requiring 6 patients surgical reintervention. In those PD cases, a caliper was used in 28 (49.1%) patients, without finding significant differences between them (P = .586). Nor were there significant differences between PD and obesity (P = .510), type of hiatal hernia (P = .326), or surgical technique (P = .428). After a median follow-up of 50.5 months, quality of life was classified as Visick I-II, III, and IV in 76.6%, 6.9% and 1.2% of the cases, respectively. CONCLUSION No association between PD and the use of calipers, surgical technique or type of hiatal hernia was found in our series.
- Published
- 2021
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