Background/Aims: Chronic intestinal pseudo-obstruction (CIPO) is a rare cause of intestinal dysmotility. First-line treatment in adult patients is medical and nutritional therapy. For patients who fail these treatment options, surgical interventions may be an option. In this scoping review, we aim to investigate the current research on surgical interventions for CIPO in adults. Methods: PubMed, Embase, and Scopus were queried for articles related to surgical interventions for adults with CIPO. Search terms included:intestinal dysmotility, intestinal pseudo-obstruction, global intestinal dysmotility, chronic intestinal pseudo-obstruction, gastrointestinal paresis, neurogastrointestinal motility disorder, and chronic small intestinal motility disorder. Results: Initial search identified 4763 records; 4722 were deemed irrelevant after screening and were excluded. The remaining 41 reports were retrieved and assessed for eligibility. Twenty-one additional studies were excluded after in-depth assessment. The remaining 20 reportswere: 9 cohort studies, 7 case reports, and 4 reviews. Of these, 10 studies had study populations of < 10 patients, while 6 had ≥ 10patients. The remaining 4 were reviews. Results of these papers described the safety and effectiveness of various surgical interventions for adults with CIPO, including percutaneous endoscopic procedures, surgical decompression, small bowel resection, and intestinal transplantation. Conclusions Data pertaining to surgical therapy for CIPO is limited. Although this review suggests that surgical interventions for CIPO may be safe and effective for select patients, strong conclusions cannot be made due to limited number of relevant studies and small sample sizes.Concerted efforts to produce data from large studies on adults with CIPO are necessary.

Background/Aims: Chronic intestinal pseudo-obstruction (CIPO) is a rare cause of intestinal dysmotility. First-line treatment in adult patients is medical and nutritional therapy. For patients who fail these treatment options, surgical interventions may be an option. In this scoping review, we aim to investigate the current research on surgical interventions for CIPO in adults. Methods: PubMed, Embase, and Scopus were queried for articles related to surgical interventions for adults with CIPO. Search terms included:intestinal dysmotility, intestinal pseudo-obstruction, global intestinal dysmotility, chronic intestinal pseudo-obstruction, gastrointestinal paresis, neurogastrointestinal motility disorder, and chronic small intestinal motility disorder. Results: Initial search identified 4763 records; 4722 were deemed irrelevant after screening and were excluded. The remaining 41 reports were retrieved and assessed for eligibility. Twenty-one additional studies were excluded after in-depth assessment. The remaining 20 reportswere: 9 cohort studies, 7 case reports, and 4 reviews. Of these, 10 studies had study populations of < 10 patients, while 6 had ≥ 10patients. The remaining 4 were reviews. Results of these papers described the safety and effectiveness of various surgical interventions for adults with CIPO, including percutaneous endoscopic procedures, surgical decompression, small bowel resection, and intestinal transplantation. Conclusions Data pertaining to surgical therapy for CIPO is limited. Although this review suggests that surgical interventions for CIPO may be safe and effective for select patients, strong conclusions cannot be made due to limited number of relevant studies and small sample sizes.Concerted efforts to produce data from large studies on adults with CIPO are necessary.

Background/Aims: Chronic intestinal pseudo-obstruction (CIPO) is a rare cause of intestinal dysmotility. First-line treatment in adult patients is medical and nutritional therapy. For patients who fail these treatment options, surgical interventions may be an option. In this scoping review, we aim to investigate the current research on surgical interventions for CIPO in adults. Methods: PubMed, Embase, and Scopus were queried for articles related to surgical interventions for adults with CIPO. Search terms included:intestinal dysmotility, intestinal pseudo-obstruction, global intestinal dysmotility, chronic intestinal pseudo-obstruction, gastrointestinal paresis, neurogastrointestinal motility disorder, and chronic small intestinal motility disorder. Results: Initial search identified 4763 records; 4722 were deemed irrelevant after screening and were excluded. The remaining 41 reports were retrieved and assessed for eligibility. Twenty-one additional studies were excluded after in-depth assessment. The remaining 20 reportswere: 9 cohort studies, 7 case reports, and 4 reviews. Of these, 10 studies had study populations of < 10 patients, while 6 had ≥ 10patients. The remaining 4 were reviews. Results of these papers described the safety and effectiveness of various surgical interventions for adults with CIPO, including percutaneous endoscopic procedures, surgical decompression, small bowel resection, and intestinal transplantation. Conclusions Data pertaining to surgical therapy for CIPO is limited. Although this review suggests that surgical interventions for CIPO may be safe and effective for select patients, strong conclusions cannot be made due to limited number of relevant studies and small sample sizes.Concerted efforts to produce data from large studies on adults with CIPO are necessary.

Background: To compare clinical outcomes following lateralized reverse shoulder arthroplasty (RSA) versus RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative active external rotation (ER). Methods: We performed a systematic review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of RSA with LDT or lateralized RSA alone performed in patients with preoperative ER ≤0°. Our primary outcomes were active ER, active forward elevation (FE), Constant score, and the incidence of complications. Results: We included 12 RSA with LDT studies with 188 shoulders and 4 lateralized RSA without transfer studies with 250 shoulders. Mean preoperative ER in RSA with LDT was –14°, while mean preoperative ER in lateralized RSA alone was –11°. Lateralized RSA alone was associated with superior postoperative ER (28° vs. 22°, P=0.010) and Constant score (69 vs. 65, P=0.014), but similar postoperative FE (P=0.590). Pre- to postoperative improvement in ER and FE was similar between cohorts. RSA with LDT had a higher incidence of nerve-related complications (2.1% vs. 0%) and dislocation (2.8% vs. 0.8%) compared to lateralized RSA alone. Conclusions Both RSA with LDT and lateralized RSA are reliable options to restore ER in patients with significantly limited preoperative ER. Our analysis suggests that lateralized RSA alone is superior to RSA with LDT in patients with either a medialized or lateralized implant design and confers a lower risk of complications, particularly nerve injury and dislocation. However, the addition of an LDT may still be indicated in certain patient populations with very severe ER loss.Level of evidence: IV.

Background: This study sought to determine if preoperative forward elevation (FE) weakness affects outcomes of anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA). Methods: A retrospective review of a single institution’s prospectively collected shoulder arthroplasty database was performed between 2007 and 2020, including 333 aTSAs and 155 rTSAs for primary RCI-GHOA with a minimum 2-year follow-up. Defining preoperative weakness as FE strength ≤4.9 lb (2.2 kg), three cohorts were matched 1:1:1 by age, sex, and follow-up: weak (n=82) to normal aTSAs, weak (n=44) to normal rTSAs, and weak aTSAs (n=61) to weak rTSAs. Compared outcomes included range of motion, outcome scores, and complication and revision rates at latest follow-up. Results: Weak aTSAs and weak rTSAs achieved similar postoperative outcome measures to normal aTSAs and normal rTSAs, respectively (P>0.05). Compared to weak rTSAs, weak aTSAs achieved superior postoperative passive (P=0.006) and active external rotation (ER) (P=0.014) but less favorable postoperative Shoulder Pain and Disability Index (P=0.032), American Shoulder and Elbow Surgeons (P=0.024), and University of California, Los Angeles scores (P=0.008). Weak aTSAs achieved the minimal clinically important difference and substantial clinical benefit at a lower rate for abduction (P=0.045 and P=0.003) and FE (P=0.011 and P=0.001). Weak aTSAs had a higher revision rate (P=0.025) but a similar complication rate (P=0.291) compared to weak rTSAs. Conclusions Patients with RCI-GHOA and preoperative FE weakness obtain postoperative outcomes similar to patients with normal preoperative strength after either aTSA or rTSA. Preoperatively, weak aTSAs achieved greater ER but lower rates of clinically relevant improvement in overhead motion compared to weak rTSAs.Level of evidence: III.

Background: To compare clinical outcomes following lateralized reverse shoulder arthroplasty (RSA) versus RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative active external rotation (ER). Methods: We performed a systematic review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of RSA with LDT or lateralized RSA alone performed in patients with preoperative ER ≤0°. Our primary outcomes were active ER, active forward elevation (FE), Constant score, and the incidence of complications. Results: We included 12 RSA with LDT studies with 188 shoulders and 4 lateralized RSA without transfer studies with 250 shoulders. Mean preoperative ER in RSA with LDT was –14°, while mean preoperative ER in lateralized RSA alone was –11°. Lateralized RSA alone was associated with superior postoperative ER (28° vs. 22°, P=0.010) and Constant score (69 vs. 65, P=0.014), but similar postoperative FE (P=0.590). Pre- to postoperative improvement in ER and FE was similar between cohorts. RSA with LDT had a higher incidence of nerve-related complications (2.1% vs. 0%) and dislocation (2.8% vs. 0.8%) compared to lateralized RSA alone. Conclusions Both RSA with LDT and lateralized RSA are reliable options to restore ER in patients with significantly limited preoperative ER. Our analysis suggests that lateralized RSA alone is superior to RSA with LDT in patients with either a medialized or lateralized implant design and confers a lower risk of complications, particularly nerve injury and dislocation. However, the addition of an LDT may still be indicated in certain patient populations with very severe ER loss.Level of evidence: IV.

Background: This study sought to determine if preoperative forward elevation (FE) weakness affects outcomes of anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA). Methods: A retrospective review of a single institution’s prospectively collected shoulder arthroplasty database was performed between 2007 and 2020, including 333 aTSAs and 155 rTSAs for primary RCI-GHOA with a minimum 2-year follow-up. Defining preoperative weakness as FE strength ≤4.9 lb (2.2 kg), three cohorts were matched 1:1:1 by age, sex, and follow-up: weak (n=82) to normal aTSAs, weak (n=44) to normal rTSAs, and weak aTSAs (n=61) to weak rTSAs. Compared outcomes included range of motion, outcome scores, and complication and revision rates at latest follow-up. Results: Weak aTSAs and weak rTSAs achieved similar postoperative outcome measures to normal aTSAs and normal rTSAs, respectively (P>0.05). Compared to weak rTSAs, weak aTSAs achieved superior postoperative passive (P=0.006) and active external rotation (ER) (P=0.014) but less favorable postoperative Shoulder Pain and Disability Index (P=0.032), American Shoulder and Elbow Surgeons (P=0.024), and University of California, Los Angeles scores (P=0.008). Weak aTSAs achieved the minimal clinically important difference and substantial clinical benefit at a lower rate for abduction (P=0.045 and P=0.003) and FE (P=0.011 and P=0.001). Weak aTSAs had a higher revision rate (P=0.025) but a similar complication rate (P=0.291) compared to weak rTSAs. Conclusions Patients with RCI-GHOA and preoperative FE weakness obtain postoperative outcomes similar to patients with normal preoperative strength after either aTSA or rTSA. Preoperatively, weak aTSAs achieved greater ER but lower rates of clinically relevant improvement in overhead motion compared to weak rTSAs.Level of evidence: III.

Background: To compare clinical outcomes following lateralized reverse shoulder arthroplasty (RSA) versus RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative active external rotation (ER). Methods: We performed a systematic review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of RSA with LDT or lateralized RSA alone performed in patients with preoperative ER ≤0°. Our primary outcomes were active ER, active forward elevation (FE), Constant score, and the incidence of complications. Results: We included 12 RSA with LDT studies with 188 shoulders and 4 lateralized RSA without transfer studies with 250 shoulders. Mean preoperative ER in RSA with LDT was –14°, while mean preoperative ER in lateralized RSA alone was –11°. Lateralized RSA alone was associated with superior postoperative ER (28° vs. 22°, P=0.010) and Constant score (69 vs. 65, P=0.014), but similar postoperative FE (P=0.590). Pre- to postoperative improvement in ER and FE was similar between cohorts. RSA with LDT had a higher incidence of nerve-related complications (2.1% vs. 0%) and dislocation (2.8% vs. 0.8%) compared to lateralized RSA alone. Conclusions Both RSA with LDT and lateralized RSA are reliable options to restore ER in patients with significantly limited preoperative ER. Our analysis suggests that lateralized RSA alone is superior to RSA with LDT in patients with either a medialized or lateralized implant design and confers a lower risk of complications, particularly nerve injury and dislocation. However, the addition of an LDT may still be indicated in certain patient populations with very severe ER loss.Level of evidence: IV.

Background: This study sought to determine if preoperative forward elevation (FE) weakness affects outcomes of anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA). Methods: A retrospective review of a single institution’s prospectively collected shoulder arthroplasty database was performed between 2007 and 2020, including 333 aTSAs and 155 rTSAs for primary RCI-GHOA with a minimum 2-year follow-up. Defining preoperative weakness as FE strength ≤4.9 lb (2.2 kg), three cohorts were matched 1:1:1 by age, sex, and follow-up: weak (n=82) to normal aTSAs, weak (n=44) to normal rTSAs, and weak aTSAs (n=61) to weak rTSAs. Compared outcomes included range of motion, outcome scores, and complication and revision rates at latest follow-up. Results: Weak aTSAs and weak rTSAs achieved similar postoperative outcome measures to normal aTSAs and normal rTSAs, respectively (P>0.05). Compared to weak rTSAs, weak aTSAs achieved superior postoperative passive (P=0.006) and active external rotation (ER) (P=0.014) but less favorable postoperative Shoulder Pain and Disability Index (P=0.032), American Shoulder and Elbow Surgeons (P=0.024), and University of California, Los Angeles scores (P=0.008). Weak aTSAs achieved the minimal clinically important difference and substantial clinical benefit at a lower rate for abduction (P=0.045 and P=0.003) and FE (P=0.011 and P=0.001). Weak aTSAs had a higher revision rate (P=0.025) but a similar complication rate (P=0.291) compared to weak rTSAs. Conclusions Patients with RCI-GHOA and preoperative FE weakness obtain postoperative outcomes similar to patients with normal preoperative strength after either aTSA or rTSA. Preoperatively, weak aTSAs achieved greater ER but lower rates of clinically relevant improvement in overhead motion compared to weak rTSAs.Level of evidence: III.

Background: To compare clinical outcomes following lateralized reverse shoulder arthroplasty (RSA) versus RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative active external rotation (ER). Methods: We performed a systematic review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of RSA with LDT or lateralized RSA alone performed in patients with preoperative ER ≤0°. Our primary outcomes were active ER, active forward elevation (FE), Constant score, and the incidence of complications. Results: We included 12 RSA with LDT studies with 188 shoulders and 4 lateralized RSA without transfer studies with 250 shoulders. Mean preoperative ER in RSA with LDT was –14°, while mean preoperative ER in lateralized RSA alone was –11°. Lateralized RSA alone was associated with superior postoperative ER (28° vs. 22°, P=0.010) and Constant score (69 vs. 65, P=0.014), but similar postoperative FE (P=0.590). Pre- to postoperative improvement in ER and FE was similar between cohorts. RSA with LDT had a higher incidence of nerve-related complications (2.1% vs. 0%) and dislocation (2.8% vs. 0.8%) compared to lateralized RSA alone. Conclusions Both RSA with LDT and lateralized RSA are reliable options to restore ER in patients with significantly limited preoperative ER. Our analysis suggests that lateralized RSA alone is superior to RSA with LDT in patients with either a medialized or lateralized implant design and confers a lower risk of complications, particularly nerve injury and dislocation. However, the addition of an LDT may still be indicated in certain patient populations with very severe ER loss.Level of evidence: IV.