Concurrent laparoscopic sleeve gastrectomy with uvulopalatopharyngoplasty in the treatment of morbid obesity comorbid with severe obstructive sleep apnea: a retrospective cohort study

This study aimed to evaluate the safety and short-term effect of contemporaneous surgeries (Bariatric surgery plus uvulopalatopharyngoplasty (UPPP)) in the treatment of morbid obesity comorbid with severe obstructive sleep apnea(OSA).A retrospective cohort study was performed to identify patients with obesity and severe OSA who underwent laparoscopic sleeve gastrectomy (LSG) with or without UPPP surgeries between December 2019 and December 2021 in our center. Patients were divided into two groups according to different surgical methods (contemporaneous group [LSG with UPPP] vs LSG only group). Data about surgical safety, OSA remission, and effectiveness of weight loss were collected and analyzed between the two groups before and 12 months after surgery.A total of 101 patients were included in this study (contemporaneous group [LSG with UPPP], n=42 vs LSG only group, n=59). There was no significant difference in surgical safety between the two groups, while both OSA and obesity were significantly improved after 12.5±2.1 months postoperative follow-up. The apnea-hypopnea index(AHI) decreased from 68.7±30.4/h to 10.2±7.0/h in the contemporaneous group (P <0.001) and from 64.7±26.2/h to 18.9±9.8/h in the LSG group (P <0.001). Moreover, the AHI decreased to below 5/h in 50% of patients (21/42) in the contemporaneous group while only in 13.5% in LSG group (P <0.001). In the LSG group 20 (34%) patients achieved a reduction in AHI <15 and resolution of daytime sleepiness.Contemporaneous surgery (concurrent bariatric and UPPP surgeries) is feasible and an effective option for patients with obesity and severe OSA. However, our finding suggests that approximately a third of patients undergoing LSG with UPPP may not derive significant benefit from the UPPP portion of the contemporaneous surgical approach.