CTV04 - Update on the surgical management of xiphoidalgia

Introduction/

Purpose: In the context of thoracic injury, a myriad of conditions cause post-operative pain complicating patient-recovery. Our clinical investigation suggested the hypothesis that Xiphoidynia, severe recurrent epigastric or sternal chest pain associated with nausea, vomiting, and radiation of pain to the back, shoulders, arms, neck, and chest wall with palpation of the xiphoid process, breathing, or abdominal musculature usage, is a sparsely-reported yet common post-thoracic injury manifestation manageable via xiphoidectomy (Yurvati Procedure).Methods or

Case Description: Patients were routinely diagnosed via standard structural osteopathic palpatory techniques to determine pre-interventional pain scores, and reassessed post-xiphoidectomy with corresponding pain scores. Statistical analysis of pre- and post- operative pain scale comparison was completed via a nonparametric Mann-Whitney U-test.Outcomes: 96 patients diagnosed with Xiphoidynia were enrolled (61 male, 35 female) with age-range distribution from 14 to 73 (mean age 27 ± 6.5 years). The most common risk factors were sports injuries, motor vehicle crashes, and prior laparoscopic procedures. All patients exhibited Xiphoidynia symptomology for >2 years prior to enrollment. Standard 0-to-10 pain scaling (0 = no pain, 10 = worst pain) was used to assess patient-status pre- and post- operatively (4 weeks and 6 weeks) yielded mean pre-operative scores of 9.0, 4-week mean post-operative scores of 4.0 (p >0.001), and 6-week mean post-operative scores of 2.0 (p >0.001). All patients demonstrated significant improvement post-operatively at 4 and 6 weeks.

Conclusion: There was significant reduction in pain post-xiphoidectomy in patients presenting with Xiphoidynia of >2-years duration. The severity of the Xiphoidynia may have prognostic significance in this population.