Vessel sealing system uvulopalatoplasty versus uvulopalatal flap: a randomized, controlled study of efficacy and adverse effects.

Abstract

The objective of this randomized, controlled study is to compare intraoperative blood loss, operative time, postoperative pain and postoperative adverse effects (bleeding, velopharyngeal insufficiency and others) between vessel sealing system uvulopalatoplasty (VSSU) and uvulopalatal flap (UPF). The study was conducted at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 31 subjects with sleep-disordered breathing and obstruction at the retropalatal level were enrolled consecutively. Intervention was randomized by mixed block randomization into 2 groups (UPF, VSSU). Stratification was also done by the presence or absence of concomitant tonsillectomy. Measured outcomes, which were blinded to patients and outcome assessor, were intraoperative blood loss, operative time, postoperative pain, postoperative bleeding, postoperative velopharyngeal insufficiency and other adverse effects. Median (IQR) of intraoperative blood loss from VSSU and UPF was 0.00 (0.00-1.00) and 6.00 (1.25-12.75) ml (p < 0.001). Median (IQR) of operative time from VSSU and UPF was 3.50 (3.00-5.00) and 15.00 (12.25-18.00) min (p < 0.001). There was significantly less pain in VSSU group on operative day (p = 0.001) and postoperative day 1 (p = 0.009). However, no significant difference of pain on postoperative day 2 to day 14 (p = 0.055-0.983) between both groups. Regarding postoperative bleeding, 1 case of immediate bleeding in UPF group and 1 case of delayed bleeding in VSSU group were found in this study. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups. In conclusion, VSSU was better than UPF in terms of less intraoperative blood loss, less operative time and less pain in early postoperative period. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups.

• Authors: Prakobkiat Hirunwiwatkul, Jesada Kanjanaumporn
• Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Eur Arch Otorhinolaryngol) Vol. 268 Issue 9 Pg. 1383-90 (Sep 2011) ISSN: 1434-4726 [Electronic] Germany
• PMID: 21400127 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Blood Loss, Surgical (prevention & control)
• Electrocoagulation (instrumentation)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Pain, Postoperative (physiopathology)
• Palate, Soft (surgery)
• Postoperative Complications (physiopathology, prevention & control)
• Postoperative Hemorrhage (physiopathology, prevention & control)
• Preoperative Care (methods)
• Reference Values
• Severity of Illness Index
• Single-Blind Method
• Sleep Apnea Syndromes (diagnosis, surgery)
• Statistics, Nonparametric
• Surgical Flaps
• Tonsillectomy (adverse effects, methods)
• Treatment Outcome
• Uvula (surgery)
• Velopharyngeal Insufficiency (etiology, physiopathology)
• Young Adult