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Excision of the Xiphoid Process for Chronic Pain: Patient Characteristics and Results
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A5860 - Excision of the Xiphoid Process for Chronic Pain: Patient Characteristics and Results
Author Block: A. Swarup1, J. D. Phillips2, D. J. Finley2, T. M. Millington2; 1General Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States, 2Thoracic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.
Rationale Xiphoidynia is a potentially debilitating chronic pain syndrome without consistent treatment guidelines. Although xiphoidectomy is performed on occasion, there is few data on its effectiveness. The purpose of this series is to determine whether xiphoid excision effectively relieves pain in this patient population, particularly in those refractory to medical management. Methods We reviewed a single-institution database of all patients treated surgically for xiphodynia over a 3 year period. Five patients underwent xiphoidectomy for chronic pain. Possible factors predisposing to xiphoidynia were analyzed and the success of pre-operative medical management, if any, was assessed. Imaging, when available, was reviewed to determine whether any consistent anatomic features were present. Results Out of the five patients who underwent xiphoidectomy, four (80%) had significant intentional weight loss and one developed pain years after traumatic paraplegia. In each case a protuberant xiphoid process was noted on physical exam and radiographs. All of the patients had been worked up for other causes of pain with no results. Three of the five patients were treated initially with other modalities such as anti-inflammatory agents or injection of local anesthetics with no improvement. In each case the xiphoid process was completely excised at the sternoxiphoid joint. Sixty percent of patients were discharged the day of surgery and the mean duration of stay was 1 day. At follow-up, all five patients reported improvement or resolution of their pain and no complications occurred. Conclusions In patients with xiphoidynia, resection is effective at relieving pain. The procedure can generally be performed as an outpatient and the risks are low. Early xiphoidectomy should be considered for patients complaining of xiphoidynia, particularly when a protuberant xiphoid process and history of antecedent weight loss are present.
Author Block: A. Swarup1, J. D. Phillips2, D. J. Finley2, T. M. Millington2; 1General Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States, 2Thoracic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.
Rationale Xiphoidynia is a potentially debilitating chronic pain syndrome without consistent treatment guidelines. Although xiphoidectomy is performed on occasion, there is few data on its effectiveness. The purpose of this series is to determine whether xiphoid excision effectively relieves pain in this patient population, particularly in those refractory to medical management. Methods We reviewed a single-institution database of all patients treated surgically for xiphodynia over a 3 year period. Five patients underwent xiphoidectomy for chronic pain. Possible factors predisposing to xiphoidynia were analyzed and the success of pre-operative medical management, if any, was assessed. Imaging, when available, was reviewed to determine whether any consistent anatomic features were present. Results Out of the five patients who underwent xiphoidectomy, four (80%) had significant intentional weight loss and one developed pain years after traumatic paraplegia. In each case a protuberant xiphoid process was noted on physical exam and radiographs. All of the patients had been worked up for other causes of pain with no results. Three of the five patients were treated initially with other modalities such as anti-inflammatory agents or injection of local anesthetics with no improvement. In each case the xiphoid process was completely excised at the sternoxiphoid joint. Sixty percent of patients were discharged the day of surgery and the mean duration of stay was 1 day. At follow-up, all five patients reported improvement or resolution of their pain and no complications occurred. Conclusions In patients with xiphoidynia, resection is effective at relieving pain. The procedure can generally be performed as an outpatient and the risks are low. Early xiphoidectomy should be considered for patients complaining of xiphoidynia, particularly when a protuberant xiphoid process and history of antecedent weight loss are present.
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