Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery

Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion,representing their morphological relationship in the axial plane.Along with the increasing understanding of hip dysplasia in recent years,numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia.At present,the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery.As an important surgery index,combined femoral and acetabular anteversion have a crucial role in these surgeries.Herein,we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia,total hip replacement,and redirectional hip preservation surgery.

Analysis of acupoint massage combined with touch on relieving anxiety and pain in patients with oral implant surgery

BACKGROUND Oral implant surgery is an effective procedure for artificial implants in missing tooth areas under local anesthesia.Because patients under local anesthesia are conscious during this procedure,compared with general anesthesia-related operations,they are more likely to experience negative emotions,such as anxiety and tension.These emotional reactions result in shivering and chills in the limbs,leading to poor doctor-patient cooperation and even avoidance of treatment.In traditional Chinese medicine,it is believed that acupoint massage regulates blood and Qi,dredge menstruation,and relieve pain,which is beneficial for patients’emotional adjustment;however,there are few related clinical studies.AIM To observe the changes in anxiety and pain in patients with oral implant after acupoint massage combined with touch therapy.METHODS One hundred patients undergoing oral implantation in our hospital between May 2020 and May 2023 were randomly divided into control and study groups,according to a random number table,with 50 patients in each group.The control group received routine intervention,and the study group received acupoint massage combined with touch on the basis of the control group.Anxiety[assessed using the Modified Dental Anxiety Scale(MDAS)],pain severity,blood pressure,heart rate,and satisfaction were compared between the two groups.RESULTS Before intervention,the difference in MDAS score between the two groups was not significant(P>0.05),while after the intervention,the MDAS scores decreased in both groups compared with those before the intervention(P<0.05);the MDAS score of the study group was lower than that of the control group,with a statistically significant difference(P<0.05).The degree of pain in the intervention group was significantly lower than that in the control group(P<0.05).Before the intervention,there were no significant differences in systolic and diastolic blood pressures or heart rate between the two groups(P>0.05).The systolic and diastolic blood pressures and heart rate in the intervention group,during and after the intervention,were significantly lower than those in the control group(P<0.05).The total degree of satisfaction in the study group was significantly higher than that in the control group(P<0.05).CONCLUSION Acupoint massage combined with touch better relieves anxiety and pain in patients undergoing dental implant surgery,improving the perioperative comfort of these patients and ensuring safety and a smooth operation.

Transoral robotic surgery for adult parapharyngeal lymphangioma:A case report

BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children.The most common sites of presentation is the head and neck region,less commonly seen in axilla,chest,liver,spleen,etc.The ideal modality of treatment has always been surgical excision irrespective of the site and age group.But with the advent of minimally invasive surgical techniques,it is now possible to perform excision of parapharyngeal space lesions with minimal morbidity and good clearance.CASE SUMMARY A 42-year-old male patient who presented with difficulty in swallowing and had undergone surgery twice outside,where Transcervical approach was attempted to remove the parapharyngeal mass,but failed.Magnetic resonance imaging scan demonstrated a 6 cm x 5 cm x 4 cm left parapharyngeal mass.He underwent transoral robotic surgery for the excision of the parapharyngeal lesion and had an uneventful post-operative recovery.CONCLUSION Lymphangiomas are hamartomatous swellings which are benign in nature.The symptoms of the patient with large parapharyngeal mass include dysphagia,dyspnoea and neck swelling.Clinicoradiological evaluation is of utmost importance to determine the adjacent vital structures and the approach to the tumor.With the advent of robotics in oncology,transoral robotic excision is one of the best approaches to perform such a surgery.

'Hippocampal innate inflammatory gliosis only'-the future role of surgery in a novel temporal lobe epilepsy syndrome

Epilepsy is one of the most common neurological conditions affecting more than 50 million people worldwide(https://www.who.int/news-room/fact-sheets/detail/epilepsy).Despite numerous antiseizure medications(ASM),approximately 30%of all patients will develop drug-resistant epile psy(DRE).DRE leads to devastating health and socioeconomic consequences(Luoni et al.,2011).

Remain Aggressive Behavior in Children with Temporal Lobe Epilepsy after Surgery

Behavioral problems have a high rate in patients with temporal lobe epilepsy but there have been few detailed reports about pediatric patients. We report two children with temporal lobe epilepsy who manifest behavior abnormality remaining after surgery. One child developed complex partial seizures at 10 years and 3 months of age caused by a left temporal ganglioglioma and manifested behavioral problems of lability, aggression, impulsivity and disinhibition. Seizures were relieved after temporal lobe resection at 10 years and 8 months of age but behavioral symptoms had been remained. The second child developed epilepsy at 3 years of age. He manifested similar behavioral problems at 7 years old. Seizures were relieved after temporal lobe resection at 13 years old but behavioral symptoms had been remained. Their courses suggested that aggressive behavior might be associated with not only temporal lesion but also other lesions such as frontal lobe or neural circuitry between both lobes. It is important to inform families of patients that behavioral disorders may not improve after epileptic surgery.

Application of machine learning in oral and maxillofacial surgery

Oral and maxillofacial anatomy is extremely complex,and medical imaging is critical in the diagnosis and treatment of soft and bone tissue lesions.Hence,there exists accumulating imaging data without being properly utilized over the last decades.As a result,problems are emerging regarding how to integrate and interpret a large amount of medical data and alleviate clinicians’workload.Recently,artificial intelligence has been developing rapidly to analyze complex medical data,and machine learning is one of the specific methods of achieving this goal,which is based on a set of algorithms and previous results.Machine learning has been considered useful in assisting early diagnosis,treatment planning,and prognostic estimation through extracting key features and building mathematical models by computers.Over the past decade,machine learning techniques have been applied to the field of oral and maxillofacial surgery and increasingly achieved expert-level performance.Thus,we hold a positive attitude towards developing machine learning for reducing the number of medical errors,improving the quality of patient care,and optimizing clinical decision-making in oral and maxillofacial surgery.In this review,we explore the clinical application of machine learning in maxillofacial cysts and tumors,maxillofacial defect reconstruction,orthognathic surgery,and dental implant and discuss its current problems and solutions.

450 nm diode laser:A new help in oral surgery

AIM To describe the performance of 450 nm diode laser in oral surgery procedures.METHODS The case described consisted of the removal of a lower lip fibroma through a blue diode laser(λ = 450 nm). RESULTS The efficacy of this device, even at very low power(1W, CW), allows us to obtain very high intra and postoperative comfort for the patient, even with just topical anaesthesia and without needing suture. The healing process was completed in one week and, during the follow-up, the patient did not report any problems, pain or discomfort even without the consumption of any kind of drugs, such as painkillers and antibiotics. The histological examination performed by the pathologist showed a large area of fibrous connective tissue with some portions of epithelium-connective detachments and a regular incision with very scanty areas of carbonization.CONCLUSION The 450 nm diode laser proved of being very efficient in the oral soft tissue surgical procedures, with no side effects for the patients.

Indocyanine green:The guide to safer and more effective surgery

In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.

Intragastric surgery using laparoscopy and oral endoscopy for gastric submucosal tumors

We review the techniques and outcomes of the intragastric resection for gastric submucosal tumors(GSTs) using laparoscope and oral endoscope. In the literature, the mean operation time, intraoperative blood loss, pathological size of the tumor and postoperative hospital stay were 134 min, minimal, 31 mm and 6.4 d, respectively. There were no particular perioperative complications during the follow-up period(mean: 121.3 mo). Intragastric surgery using laparoscopy and oral endoscopy can be considerably beneficial for patients with GSTs locating in the upper third of the stomach between 2-5 cm in diameter and < 8 cm2 in crosssectional area and located in the upper third of the stomach.

Changes in oral trace gas concentrations following orthognathic surgery and intermaxillary fixation: a case study using selected ion flow tube mass spectrometry

Orthognathic surgery is frequently accompanied by intermaxillary fixation. Intermaxillary fixation impedes the maintenance of effective oral hygiene and prolonged fixation can result in periodontal disease. A potential shorter term effect is the generation of oral malodour. It is unclear, however, as to how the production of malodorous compounds in the oral cavity is altered post-surgery. Oral air concentration of sulphur containing compounds, short chain organic acids, ammonia, isoprene and acetone were measured using selected ion flow tube-mass spectrometry in a patient who had undergone orthognathic surgery with subsequent intermaxillary fixation. Total sulphide levels rose approximately 5-fold during fixation with metal ties, with smaller increases recorded for the other compounds measured with the exception of isoprene which remained close to baseline levels. Organic acid levels declined markedly once elastic ties had replaced metal ties, with a lesser reduction being observed in sulphide levels, with both declining further after the commencement of a chlorhexidinecontaining mouthwash. These data suggest that bacterial generation of a variety of malodorous compounds increases markedly following intermaxillary fixation. This single case also suggests that the use of elastic ties and effective oral hygiene techniques, including the use of chlorhexidine mouthwash, may help ameliorate such post-surgical effects.

Protocol for the management of oral surgery patients on warfarin utilizing a Point-of-Care In-Office international normalized ratio monitoring device

Purpose: This study was performed to assess the utility and safety of an In-Office INR Monitoring Device and present a safe and efficient protocol for the management of patients on oral anticoagulants and/or antithrombolytics requiring routine office oral and maxillofacial surgery. Patients and Methods: Sixty-one patients requiring “minor” oral and maxillofacial surgery being treated chronically with oral anticoagulation (warfarin) were entered into the study and compared in 2 groups. The control group (n = 29) was managed by discontinuing warfarin and any anti-platelet medication(s) prior to surgery. In the study group (n = 30), the decision to continue or withhold warfarin was determined by a protocol in which patients are 1) stratified based on risk for thromboembolism, and 2) classified as requiring “major” or “minor” surgery. Procedures categorized as “minor” surgery included dental extraction(s), dental implants, soft tissue and bone biopsies, and preprosthetic bone surgery, and incision and drainage. Warfarin and antiplatelet medication were not withheld in these patients, and a Point-of-Care In-Office INR Monitoring Device was used to obtain INR levels on the day of consultation and surgery. Local measures including removal of granulation tissue, packing, suturing, etc. were utilized for hemostasis. Results: The 30 patients in the study group maintained on warfarin readily achieved hemostasis using intraoperative local measures. The mean INR measured by the In-Office INR Monitoring Device was 2.36 with a range from 1.3 to 3.2. Study group patients underwent a total of 131 separate procedures including 108 dental extractions (impactions), placement of dental implants, preprosthetic bony surgery, bone cyst removal, soft tissue biopsies, facial skin cancer repair, and incision and drainage. One patient (3%) required “minor” intervention with removal of a “liver clot” on postop day 2 with repacking and suturing. The 29 patients in the control group discontinued off of war farin underwent a total of 99 procedures. One patient (3%) also required a “minor” intervention (repacking of extraction site). There were no “major” complications in either group. Conclusions: This study supports previous studies that minor oral surgery procedures can be safely performed while maintaining patients on warfarin minimizing the risk of a potentially devastating thromboembolic event. When deciding whether or not to withhold warfarin, this study supports the use of the proposed protocol based on 1) risk stratification for thromboembolism, 2) the need for “minor” versus “major” surgery, 3) and utilization of an In-Office INR Monitoring Device. An In-Office Point-of-Care INR measuring device can be a very effective tool to safely simplify and make the perioperative management of the anticoagulated patient more efficient for the patient and oral and maxillo facial surgeon.

Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: Techniques and efficacy

AIM: To investigate the techniques and efficacy of peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery.METHODS: An extensive English language literature search was conducted using Pub Med, MEDLINE, Medscape and Google to identify peer-reviewed original and review articles using the keywords "bariatric endoscopic suturing", "overstitch bariatric surgery", "endoscopic anastomotic reduction", "bariatric surgery", "gastric bypass", "obesity", "weight loss". We identified articles describing technical feasibility, safety, efficacy, and adverse outcomes of overstitch endoscopic suturing system for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass(RYGB). All studies that contained material applicable to the topic were considered. Retrieved peer-reviewed original and review articles were reviewed by the authors and the data extracted using a standardized collection tool. Data were analyzed using statistical analysis as percentages of the event. RESULTS: Four original published articles which met our search criteria were pooled. The total number cases were fifty-nine with a mean age of 46.75 years(34-63 years). Eight of the patients included in those studies were males(13.6%) and fifty-one were females(86.4%). The mean time elapsed since the primary bypass surgery was 5.75 years. The average pre-endoscopic procedure body mass index(BMI) was 38.68(27.5-48.5). Mean body weight regained post-RYGB surgery was 13.4 kg from their post-RYGB nadir. The average pouch length at the initial upper endoscopy was 5.75 cm(2-14 cm). The pre-intervention anastomotic diameter was averaged at 24.85 mm(8-40 mm). Average procedure time was 74 min(50-164 min). Mean post endoscopic intervention anastomotic diameter was 8 mm(3-15 mm). Weight reduction at 3 to 4 mo post revision noted to be anaverage of 10.1 kg. Average overall post revision BMI was recorded at 37.7. The combined technical and clinical success rate was 94.9%(56/59) among studied participants. CONCLUSION: Endoscopic suturing can be technically feasible, effective and safe for transoral outlet reduction in patients with weight regain following RYGB.

Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.

Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents

AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.

Benefits of post-operative oral protein supplementation in gastrointestinal surgery patients: A systematic review of clinical trials

AIM: To evaluate published trials examining oral postoperative protein supplementation in patients having undergone gastrointestinal surgery and assessment of reported results.METHODS: Database searches(MEDLINE, BIOSIS, EMBASE, Cochrane Trials, Cinahl, and CAB), searches of reference lists of relevant papers, and expert referral were used to identify prospective randomized controlled clinical trials. The following terms were used to locate articles: "oral'' or "enteral'' and "postoperative care'' or "post-surgical'' and "proteins' ' or "milk proteins' ' or "dietary proteins' ' or "dietary supplements' ' or "nutritional supplements' '. In databases that allowed added limitations, results were limited to clinical trials that studied humans, and publications between 1990 and 2014. Quality of collated studies was evaluated using a qualitative assessment tool and the collective results interpreted.RESULTS: Searches identified 629 papers of which, following review, 7 were deemed eligible for qualitative evaluation. Protein supplementation does not appear to affect mortality but does reduce weight loss, and improve nutritional status. Reduction in grip strength deterioration was observed in a majority of studies, and approximately half of the studies described reduced complication rates. No changes in duration of hospital stay or plasma protein levels were reported. There is evidence to suggest that protein supplementation should be routinely provided post-operatively to this population. However, despite comprehensive searches, clinical trials that varied only the amount of protein provided via oral nutritional supplements(discrete from other nutritionalcomponents) were not found. At present, there is some evidence to support routinely prescribed oral nutritional supplements that contain protein for gastrointestinal surgery patients in the immediate post-operative stage.CONCLUSION: The optimal level of protein supplementation required to maximise recovery in gastrointestinal surgery patients is effectively unknown, and may warrant further study.

Oral and maxillofacial surgery in China: Past, present and future

China is the most highly populated developing country. As with other scientific disciplines, dentistry (stomatology) is progressively growing since 1949 when the new China was founded. Due to the closing of the country to international discourse for several decades, international counterparts know very little about dentistry or stomatology, including the sub-discipline oral and maxillofacial surgery. This paper is aimed to introduce the scope, give a brief history, update clinical and basic research, and discuss the future of oral and maxillofacial surgery in China. It will hopefully help international colleagues to have an insight into the developmental history, education system, clinical and basic research achievements, as well as the prospective future of oral and maxillofacial surgery in

Early Surgery in Femoral Neck Fractures in Elderly: Does Preoperative ASA Score Matter?

Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours;group 2 patients treated between 48 to 96 hours;group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06);patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.

New direction for surgery:Super minimally invasive surgery

The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.

Oral Health and Masticatory Performance in Adults Submitted to Bariatric Surgery: A Pilot Study

Background: Obesity has reached epidemic patterns and constitutes a serious public health problem due to comorbidities and the impact on life quality of affected individuals. Bariatric surgery appears as one of the most recommended treatments;however much has been known about the effects of this intervention on the functional performance of the organism as a whole. Objective: To characterize the oral health of adults submitted to bariatric surgery, before and after the intervention, with emphasis on the performance of masticatory function. Methods: A prospective observational cohort study conducted in a public reference service to the treatment of obesity in the city of Recife, State of Pernambuco. The data were obtained during the first half of 2011, through interview, intraoral physical examination and evaluation of masticatory function. Statistical treatment adopted was a CI of 95% and the chi-square test. The collection was conducted in three stages, with initial assessment in the preoperative and follow-up at 60 and 180 days. Results: The sample consisted of 20 volunteers, aged between 23 and 58 years and mean BMI of 43.2 ± 2.8. When compared the pre-operative to the control periods, there were significant differences for variables with decreased tendency towards spontaneous gingival bleeding and increased tooth hypersensitivity and tooth mobility (p < 0.05). Regarding the masticatory function, we found significant differences for most of the variables investigated, except in the coordination of movements and breathing during this function. Conclusion: The performance of masticatory function shows differences in pre- and postoperative periods for bariatric surgery.

Efficacy and safety of peroral endoscopic myotomy after prior sleeve gastrectomy and gastric bypass surgery

BACKGROUND Per-oral endoscopic myotomy(POEM)is safe and effective for the treatment of achalasia.There is limited data on performance of POEM in patients with altered upper gastrointestinal anatomy,especially after bariatric surgery.Outcomes in patients with prior sleeve gastrectomy have not been reported.AIM To assess the efficacy and safety of POEM in patients with prior bariatric surgery.METHODS A prospective POEM database was reviewed from 3/2017-5/2020 to identify patients who underwent POEM after prior bariatric surgery.Efficacy was assessed by technical success(defined as the ability to successfully complete the procedure)and clinical success[decrease in Eckardt score(ES)to≤3 post procedure].Safety was evaluated by recording adverse events.RESULTS Six patients(50%male,mean age 48 years)with a history of prior bariatric surgery who underwent POEM were included.Three had prior sleeve gastrectomy(SG)and three prior Roux-en-Y gastric bypass(RYGB).Four patients had achalasia subtype II and 2 had type I.Most(4)patients had undergone previous achalasia therapy.Technical success was 100%.Clinical success was achieved in 4(67%)patients at mean follow-up of 21 mo.In one of the clinical failures,EndoFLIP evaluation demonstrated adequate treatment and candida esophagitis was noted as the likely cause of dysphagia.There were no major adverse events.CONCLUSION POEM is technically feasible after both RYGB and SG and offers an effective treatment for this rare group of patients where surgical options for achalasia are limited.