Lose weight, stop snoring! Chang Gung’s innovative surgery tackles sleep apnea and obesityJun 12, 2024


A breakthrough "composite airway and weight reduction surgery" developed by Professor Hsuen-Yu Li’s team at Chang Gung Memorial Hospital promises to simultaneously address obstructive sleep apnea (OSA) and morbid obesity. This innovative procedure combines airway surgery to treat OSA with bariatric surgery in a single anesthesia session, effectively improving sleep apnea, reducing obesity, and lowering the risk of cardiovascular and cerebrovascular diseases. 

OSA is a highly prevalent condition, affecting about 22% of men and 17% of women, according to epidemiological studies. It causes repeated airway obstructions during sleep, leading to fragmented sleep and tissue hypoxia, which negatively impacts almost all organs and systems, particularly cognitive functions and the cardiovascular system. Obesity is a major cause of OSA, with nearly 90% of patients with morbid obesity suffering from this condition. 

The composite surgery involves two parts. The first part, conducted by general surgeons, includes laparoscopic gastric reduction or gastric bypass surgery to reduce stomach volume and facilitate weight loss. The second part, performed by ENT surgeons, consists of multi-level integrated airway surgery, such as volumetric tongue ablation, soft palate reconstruction, and minimally invasive septoturbinoplasty, designed to expand the airway and improve breathing. 

Volumetric tongue ablation: Safely reducing tongue obstruction 

Volumetric tongue ablation uses a minimally invasive ablation rod to submucosally reduce and stabilize the tongue’s volume, avoiding damage to the lingual artery and muscle layer, thereby preventing swallowing difficulties. Research indicates this procedure can effectively reduce tongue tissue by 8 cubic centimeters, significantly improving airway obstruction during sleep. 

Integrated soft palate surgery: Comprehensive soft palate reconstruction 

This surgery utilizes tissue-specific techniques for soft palate reconstruction, including mucosal preservation, fat ablation, muscle suspension, and tonsillectomy. It enables three-dimensional reconstruction of the lateral pharyngeal wall and comprehensive soft palate suspension, while shortening the uvula, effectively expanding the oropharyngeal airway without damaging muscles responsible for closing the oropharynx, thus preventing symptoms of oropharyngeal insufficiency. 

Minimally invasive septoturbinoplasty: Reducing bleeding and controlling hypertension 

Traditional septoplasty can lead to complications such as septal hematoma, nosebleeds, and empty nose syndrome. To mitigate these risks, the team developed a minimally invasive septoturbinoplasty procedure with three steps: 

  1.   Preserving the anterior nasal cavity floor bone to protect the palatine vessels.
  2.   Horizontally incising at the junction of the septum and cavity floor for better drainage.
  3.   Closing the cavity left by resecting the curved septum through nasal septum suturing.

This technique uses externalization of the inferior turbinates instead of trimming, reducing the risk of bleeding and preventing empty nose syndrome. It also improves symptoms such as snoring and daytime sleepiness, enhances quality of life, and reduces sympathetic nervous system activity during sleep, aiding in hypertension control. 

Clinical outcomes of composite surgery 

Professor Li emphasized that his team has accumulated extensive experience with this composite surgery. Follow-up studies show a significant reduction in the apnea-hypopnea index (AHI) from an average of 75 to 4.5 post-surgery, with a success rate exceeding 90%. Patients also experienced an average weight loss of 34 kilograms, improved sleep quality, reduced daytime sleepiness, and a substantial improvement in overall quality of life. 

This pioneering approach represents a significant advancement in the treatment of both OSA and obesity, offering hope for improved health outcomes and reduced cardiovascular risks for patients worldwide. 

Resource (mandarin):

《新創動態》 減少體重、告別打呼!長庚創新複合手術一次解決呼吸中止與病態肥胖