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Accepted: 12 October 2017
Barbed expansion sphincter pharyngoplasty for the treatment
of oropharyngeal collapse in obstructive sleep apnoea
syndrome: A retrospective study on 17 patients
Expansion Sphincter Pharyngoplasty (ESP) is a promising surgical
technique designed to treat patients with obstructive sleep
apnoea syndrome (OSAS), characterised by oropharyngeal walls
collapse, with reduced morbidity and high success rates com-
pared to traditional uvulopalatopharyngoplasty (UPPP).
tion, the use of knotless barbed sutures has been recently
described in OSAS oropharyngeal surgery to improve the biome-
chanical effect of sutures on tissue collapse with positive
We present here our surgical technique for ESP using barbed
suture, Barbed Expansion Sphincter Pharyngoplasty (BESP), and
report the results observed in a group of 17 patients.
A retrospective evaluation of patients’ clinical records was performed
from December 2012 until January 2015.
Eligible patients had moderate-to-severe OSAS as assessed by a
recent (within 6 months of screening) polysomnography (PSG),
scored according to the American Academy of Sleep Medicine
(AASM) 2007 and 2012 criteria, BMI ≤ 30 kg/m
cant variations since the PSG, and either did not tolerate or
refused therapy with continuous positive airway pressure (CPAP).
For each patient demographic data, PSG date, BMI, AHI and ODI
were retrieved, as well as the results of the Italian version of
Patients were selected for BESP based on the presence of oropharyn-
geal collapse, as determined by preoperative complete upper airways
examination and drug-induced sleep endoscopy (DISE) using the VOTE
(Velar and Oropharyngeal) and did not present obstruc-
tion at other sites (base of Tongue and Epiglottis).
Patients complaining of nasal obstruction were scheduled to
receive turbinate reduction surgery and/or septoplasty aimed at
obtaining nasal symptom relief.
Surgery is performed under general anaesthesia, with the patient in
the supine position and with orotracheal intubation. The oral cavity
and oropharynx are exposed using a Boyle Davis mouth gag.
Bilateral tonsillectomy is performed, in patients who have already
received tonsillectomy, and the oropharyngeal mucosa is removed to
reveal the tonsillar pillars. A rectangular shaped strip of mucosa and
the underlying submucosa are removed at the centre of the soft
palate consisting of 0.5-0.7 mm in length and with width corre-
sponding to the tonsillar fossae distance (Figure 1A).
resorbable polydioxanone barbed bidirectional size 0 monofilament
Suture Device—Surgical Specialties Corporation, MA,
USA) is then used for BESP, the surgical steps are illustrated in
Figures 1B, 2A,B and 3.
The edges of the tonsillar and palatal mucosal resection are
secured together with single stitches using Vicryl 2-0 sutures.
All patients were discharged with paracetamol 1 gr three times a day
before meals and chlorhexidine 0.2% mouth rinse after meals.
Presented at the 1st EUROPEAN ADVANCED COURSE ON SURGICAL TECHNIQUES FOR
SNORING AND OSAHS, organised by the University of Rome Tor Vergata and San Carlo
Hospital in Rome, February 11th-12th, 2016, The Church Palace—Via Aurelia, 481 - 00165
CORRESPONDENCE: OUR EXPERIENCE