Early Institutional Experience with Barbed Reposition Pharyngoplasty: Perioperative Safety and Efficacy versus Expansion Sphincter Pharyngoplasty

Introduction: Barbed Reposition Pharyngoplasty (BRP) has emerged as a modification of traditional uvulopalatopharyngoplasty techniques for surgical treatment of obstructive sleep apnea (OSA). However, comparative data evaluating BRP relative to expansion sphincter pharyngoplasty (ESP) remain limited.

Methods: We retrospectively identified 22 patients undergoing BRP and matched them 1:1 to ESP controls by age, preoperative body mass index (BMI), and apnea–hypopnea index (AHI). Two analyses were performed: (1) sleep outcomes in patients with pre- and postoperative polysomnography available (10 BRP, 10 ESP), and (2) perioperative pain, opioid use, and complications in the full matched cohort, adjusting for chronic opioid use and intraoperative nerve block. Nonparametric tests were used for sleep outcomes, and mixed-effects models were used for perioperative analyses.

Results: 44 patients (22 BRP, 22 ESP) were predominantly male (72.7%), overweight (BMI 31.2 ± 2.9), with severe OSA (AHI: 40.0±21.2). BRP demonstrated a greater percent reduction in AHI compared with ESP (−43.2% vs. −31.0%), though not reaching statistical significance (p=0.49). Responder rates were similar between groups. Operative time was significantly shorter for BRP (67.4 vs. 80.0 minutes, p=0.002). After adjustment, ESP patients required higher postoperative fentanyl dosing (p=0.002). Length of stay, pain scores, pain-related outreach, and opioid refill requests were similar between groups. Notably, zero 30-day postoperative complications were observed in BRP patients, whereas 3 ESP patients (13.6%) experienced complications (infection, bleeding requiring intervention, and readmission).

Conclusions: BRP offers perioperative advantages over ESP, including shorter operative time, fewer complications, and reduced inpatient opioid requirements, while maintaining comparable pain control and sleep outcomes. These findings support BRP as an efficient surgical option for selected OSA patients. Additional postoperative sleep data will be available at the time of presentation to further clarify comparative efficacy.