Re: UPPP-Is it so bad?
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Re: UPPP-Is it so bad?

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Posted by Captin Cannuck on March 01, 2009 at 08:24:53:

In Reply to: UPPP-Is it so bad? posted by sleepsurgeon on February 27, 2009 at 20:50:07:

Dear Dr. Li,

Thanks for your post. This is a very controvercial topic, but it is a very important one for us to understand. If it is okay with you, I would like to ask you some questions.

By the way, I should mention that you and I have met in person once before. It was on the morning of May 17th 2006 early in the morning. I came to you to see what options I had in reference to damage done to my airway following a botched LAUP surgery. You gave me some good advice. I thank you for that.

In any case, here are my questions about UPPP:

1. I read your answer to question 34 and have also read your website where you show your modified UPPP technique. In question 34, you were responding to Mrs. Capistrano's article on how her life had been adversely effected by UPPP surgery due to persistent acid reflux. In your answer you said that you felt that UPPP had a design flaw relating to the cutting of the uvula. You mentioned you have always been against the cutting of the uvula and always have lectured on the importance of not cutting the uvula. You have modified your own surgical technique so that you are not cutting the uvula. Is this correct?

2. My second question is about the recently article was published in the British Medical Journal which evaluated UPPP around the world. This was in November of last year. The author, Dr. Adam Elshaug followed people and also did a review of 18 studies from America and around the world. He found that positive benefits of UPPP lasted only 12 to 24 months and that the overall effectiveness was only 13%. He also mentioned that 62% of people who had undergone phase one surgery reported persistent side effects. He went on to express the opinion that evidence suggests that phase one is "a waste of time". He is reporting his findings to the government of Australia which is considering disinvesting in UPPP due to its poor results. I would like to ask you to please listen to this interview, and I would like to ask how you respond to his point of view. Here is the link:

http://www.adelaide.edu.au/podcasts/interviews/health/

I would like to know if you agree with what he says about the short duration of positive benefits and about the low efficacy of the procedure?

3. I would like to ask you about your opinion of a passage in Dr. Dement's book, The Promise of Sleep. Dement was writing ten years ago when he said "Often when people claim to sleep better after the UPPP surgery, an objective test in the sleep lab shows that the apnea is just as bad as before. In a few cases, apnea actually becomes worse, probably as a result of scarring at the back of the throat". I would like to know firstly, if you think that Dr. Dement's observation is correct. Secondly, if some people are getting worse after UPPP (several members of this board have had that experience) and if benefits are so fleeting, I wonder why it is worth it? Is this the reason why you modified your technique?

4. Lastly, I would like to know if you think that the studies on UPPP which have been done are sound. From what I have read, there is a huge range of results on UPPP. Some studies say that Phase one is successful in 64% of people. Other studies (e.g. the one above in the British Medical Journal) say that it is more like 13%. I would like to know if in the past, the same people who gave the surgeries did the follow up tests, interpreted the data and wrote the papers; or, were these tests done by an independent body?

Thank you for answering my questions.

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