Langenbeck's Archives of Surgery最新文献

{"title":"Lithium-associated hyperparathyroidism: a systematic review of prevalence and surgical outcomes.","authors":"Reza Alidousti Shahraki, Adrian D Meehan, Göran Wallin, Kosmas Daskalakis","doi":"10.1007/s00423-026-04200-5","DOIUrl":"https://doi.org/10.1007/s00423-026-04200-5","url":null,"abstract":"<p><strong>Purpose: </strong>Lithium remains one of the most effective maintenance treatments for bipolar disorder. However, disturbances in calcium homeostasis including hypercalcemia and lithium-associated hyperparathyroidism (LHPT) have increasingly been recognized as endocrine complications of chronic lithium therapy. The prevalence, pathophysiology, and optimal surgical management of LHPT remain incompletely defined. This systematic review aims to synthesize the available evidence on prevalence, pathophysiology, and surgical outcomes in LHPT.</p><p><strong>Methods: </strong>We conducted a systematic review according to PRISMA guidelines. Five databases (MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO) were searched. Studies reporting hypercalcemia or hyperparathyroidism in adult patients receiving lithium therapy were eligible for inclusion. Surgical case series reporting parathyroidectomy in LHPT were analyzed separately.</p><p><strong>Results: </strong>A total of 5,483 records were identified, of which 125 studies met the inclusion criteria. Hypercalcemia occurred in 7.2% (423/5,853) and HPT was confirmed in 4.8% (156/3,239) of lithium-treated patients. Multiglandular disease was identified in 25-83% of surgical cases, substantially higher than the 15-20% observed in sporadic HPT. Bilateral neck exploration was performed in the majority of surgical series. Postoperative cure rates ranged from 58% to 100%, with recurrence rates of approximately 16% at 10 years.</p><p><strong>Conclusion: </strong>LHPT represents a clinically significant endocrine complication characterized by heterogeneous pathological patterns. The elevated prevalence of multiglandular disease has important implications for surgical planning. Given the high proportion of multiglandular involvement, surgeons should maintain a low threshold for bilateral neck exploration, particularly in patients with prolonged lithium exposure or intraoperative findings suggestive of multiple gland involvement.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative outcome and predictors of success after tracheal resection.","authors":"Laura V Klotz, Birgit Khandanpour, Martin E Eichhorn, Werner Schmidt, Markus Scheiner, Dennis Aliev, Feyza Özkan, Judith M Brock, Konstantina Kontogianni, Hans Hoffmann, Felix J F Herth, Hauke Winter, Florian Eichhorn","doi":"10.1007/s00423-026-04175-3","DOIUrl":"10.1007/s00423-026-04175-3","url":null,"abstract":"<p><strong>Purpose: </strong>Tracheal stenosis (TS) leads to progressive ventilatory restriction and endoscopic interventions for symptomatic relief have often palliative character. Resection of the narrowed segment can result in sustainable long-term outcome. We analyzed our experience in tracheal reconstructive surgery with focus on perioperative management and procedural morbidity.</p><p><strong>Methods: </strong>We conducted a retrospective study of prospectively obtained clinical data from patients undergoing tracheal surgery at the Thoraxklinik Heidelberg between July 2000 and September 2023. Aim of the study was to identify clinical variables with impact on the perioperative course and individual outcome.</p><p><strong>Results: </strong>138 patients underwent tracheal surgery for TS in our department. Main indications were post-tracheostomy stenosis (n = 77, 55.8%), malignant tracheal tumor (n = 27, 19.6%) and idiopathic tracheal stenosis (n = 22, 15.9%). The latter was observed more frequently in females (95.2%, p < 0.001). Most patients were extubated in the surgical theatre (83.3%) or immediately in the early postoperative period (< 24 h, 8.7%). No 30-day or 90-day mortality was observed. 13 patients (9.4%) developed symptomatic tracheal restenosis. Only seven patients (5.1%) required endoscopic intervention. Postoperative prolonged ventilation (> 24 h postop) was associated with development of anastomotic insufficiency and wound infections. Female sex and history of idiopathic stenosis were significant risk factors for recurrent stenosis.</p><p><strong>Conclusion: </strong>Reconstructive surgery for TS results in favorable functional outcome in selected patients and is associated with a low morbidity and mortality. Patient selection and perioperative management requires an experienced multidisciplinary team.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13469379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological and bibliographical discrepancies in \"Integrating cruroplasty with laparoscopic sleeve gastrectomy: a strategy to mitigate GERD symptoms in obese patients. A randomized control trial\".","authors":"Feruzjon Bobosharipov","doi":"10.1007/s00423-026-04190-4","DOIUrl":"10.1007/s00423-026-04190-4","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and safety of laparoscopic small bowel resections with intracorporal anastomosis in emergency settings - a retrospective single centre study.","authors":"Jasmin Monika Martina Schmitt, Christoph-Thomas Germer, Sven Flemming, Johan Friso Lock, Florian Seyfried","doi":"10.1007/s00423-026-04188-y","DOIUrl":"10.1007/s00423-026-04188-y","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive surgery (MIS) is increasingly applied in complex abdominal surgery and has been associated with potential benefits compared with the open approach (OS). However, evidence on the feasibility and safety on MIS small bowel resections (SBR) in the emergency setting remains limited.</p><p><strong>Methods: </strong>The study included patients requiring emergency SBR with primary anastomosis between 01/2020 and 04/2025; data were collected from the hospital information system at a tertiary referral centre. Patient outcomes of MIS vs. open SBR with anastomosis were compared before and after propensity score matching (PSM).</p><p><strong>Results: </strong>Overall, 45 patients with SBR for isolated small bowel pathology were identified, of whom 7 (15.6%) underwent MIS. Of these (3 females, 4 males; median 70, range 29-77 years), six were diagnosed with haemorrhagic small bowel infarction and one with obstructive ileus. Postoperative Comprehensive Complication Index (CCI; median 8.7, range 0-30.8; p = 0.04) and time to first flatus (median 2, range 1-4 days; p = 0.02) were lower after MIS compared to OS. Postoperative diet progression (median 4.5, range 2-7 days) and length of stay (median 6.5 days, range 4-12 days) did not differ (length of stay: p = 0.34, diet progression: p = 0.11). There were no anastomotic leaks or revisional surgeries after MIS. The costs for MIS were lower compared to OS (EUR 5,975 vs. EUR 8,925). There were no group differences after PMS.</p><p><strong>Conclusion: </strong>Our data suggest that laparoscopic small bowel resections with intracorporal anastomosis in an emergency setting are feasible and safe in highly selected cases.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of postoperative care unit observation time following carotid endarterectomy: a targeted approach.","authors":"Alexandru Barb, Armend Salihi, Johannes Hatzl, Moritz Sebastian Bischoff, Sarah Dehne, Markus Alexander Weigand, Dittmar Böckler","doi":"10.1007/s00423-026-04109-z","DOIUrl":"10.1007/s00423-026-04109-z","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and feasibility of reducing the postoperative care unit (POCU) observation period from four hours to two hours following carotid endarterectomy (CEA) for asymptomatic, high grade carotid stenosis.</p><p><strong>Design: </strong>Monocentric, retrospective-prospective observational cohort study.</p><p><strong>Methods: </strong>The study evaluated the impact of reducing the routine POCU observation period following CEA on patient safety and early postoperative outcomes. No changes in surgical technique and anesthetic management were implemented during the study period. Beginning in March 2024, a revised postoperative monitoring protocol was implemented at our institution, reducing the standard postoperative observation time from four to two hours. For the patient cohort one year prior, between January 2023 and February 2024, a retrospective analysis was conducted. For the patients undergoing surgery from March 2024 onward, a standardized postoperative protocol was implemented in order to evaluate the new clinic standards.</p><p><strong>Results: </strong>During the study period, 382 patients underwent CEA. Of these, 209 patients (54.7%) were excluded, predominantly due to symptomatic carotid stenosis. Overall, 173 patients (45.3%) met the inclusion criteria and were included in the analysis, with 87 assigned to Group I (4-hour monitoring) and 86 to Group II (2-hour monitoring).The overall incidence of postoperative complications during POCU stay did not differ significantly between the two groups (23% vs. 25.6%, p = .76). The majority of events occurred within the first 100 minutes after surgery. Postoperative bleeding requiring readmission to the POCU and surgical revision occurred in two cases (2.3%) in Group I and in one case (1.2%) in Group II (p = 1). Transient neurologic deficits were observed in two patients (2.3%) in Group I and in one patient (1.2%) in Group II (p = 1). In all cases, neurologic symptoms resolved spontaneously during hospital stay.</p><p><strong>Conclusion: </strong>Shortening the POCU observation period after CEA in asymptomatic patients appears safe and is not associated with an increased risk of complications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing audience participation at the 43rd workshop of the german surgical working group on endocrinology (CAEK): gender balance in academic discussion dynamics in endocrine surgery.","authors":"Anna Mikl, M Kießler, M Berlet, M Martignoni, H Friess, C Chiapponi","doi":"10.1007/s00423-026-04176-2","DOIUrl":"10.1007/s00423-026-04176-2","url":null,"abstract":"<p><strong>Introduction: </strong>Although many surgical fields remain male dominated, the rising number of female medical students and physicians raises important questions about engagement dynamics within academic and professional settings. Endocrine Surgery (ES) currently demonstrates high rates of female representation among its fellows all over the world. This study examines gender differences in audience participation at the 43rd Workshop of the Surgical Working Group on Endocrinology (CAEK).</p><p><strong>Methods: </strong>Lecture sessions of the 43rd Workshop of the CAEK were prospectively observed and analyzed. The study recorded the gender appearance of chairs, speakers, participants asking the first question following each lecture and whether this influenced subsequent audience participation. Gender distributions among attendees and question patterns were compared.</p><p><strong>Results: </strong>A total of 385 participants (52% female, 48% male) attended the conference. 37 sessions were included. Overall, 63 questions were recorded. 34 (54%) came from women and 29 (46%) from men. The first question was posed by a male participant in 14 sessions (51.9%) and by a female participant in 13 sessions (48.1%). When discussion was started by a man, 65.9% of subsequent questions came from other men. 90.9% of follow-up questions came from women, when discussion was opened by another woman.</p><p><strong>Conclusion: </strong>Female participation at the 43rd Workshop CAEK was well balanced, although the gender of the first questioner influenced subsequent audience engagement, as observed in other studies. These findings suggest equitable academic engagement in endocrine surgery in Germany, while indicating that the gender of the first questioner is associated with subsequent audience participation.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possible underestimation of non-operative management success in perforated diverticulitis with distant free air : Re: Cirocchi R, Matteucci M, Mari GM et al. (2026) The role of non-operative management (NOM) in perforated diverticulitis: a systematic review. Langenbecks Arch Surg 411:79.","authors":"Muzaffer Atlı","doi":"10.1007/s00423-026-04165-5","DOIUrl":"10.1007/s00423-026-04165-5","url":null,"abstract":"<p><p>The review reported a 27.8% success rate for non-operative management in patients with distant free air and, on that basis, suggested that early surgery should be strongly considered. When we examined the published data, we were unable to reproduce this estimate. Recalculating from the information given in the review, the numerator appeared to include only studies that reported this outcome, whereas the denominator also included patients from studies in which it was not reported; on a like-for-like basis the success rate is closer to 73% than to the reported 27.8%. Several values in the distant-free-air column of Table 5 of the review also correspond exactly to the complementary failure rates, which is compatible with a labelling or reporting error. These observations concern the distant-air subgroup specifically and require verification against the original data rather than establishing that the pooled analysis is incorrect. Given the clinical weight carried by this subgroup, clarification from the authors, and a correction if the discrepancies are confirmed, would be valuable.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of a nursing care bundle combined with a clinical nursing pathway in liver transplantation and its impact on patient self-management: a randomized controlled trial.","authors":"Lili Shi, Zhiying Lei, She Wang, Qiuyun Huang, Xiuli Peng, Xiongsheng Mo","doi":"10.1007/s00423-026-04135-x","DOIUrl":"https://doi.org/10.1007/s00423-026-04135-x","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the effects of a nursing care bundle combined with a clinical nursing pathway on self-management ability, postoperative biochemical markers, medication adherence, psychological status, and quality of life among liver transplant recipients.</p><p><strong>Methods: </strong>This study was a single-center, prospective, randomized controlled trial. A total of 103 patients who underwent liver transplantation were initially screened. Three individuals were excluded due to severe postoperative complications (n = 1), incomplete medical records (n = 1), or inability to adhere to follow-up procedures (n = 1). The remaining 100 patients completed follow-up and were randomly assigned in a 1:1 ratio to either the control group (n = 50) or the intervention group (n = 50) using a random number table. The control group received routine perioperative nursing care and standard follow-up after discharge. The intervention group received a structured nursing care bundle integrated with a clinical nursing pathway under the enhanced recovery after surgery (ERAS) framework. Primary outcome included self-management ability [assessed using the Chinese version of the Exercise of Self-Care Agency Scale (ESCA)]. Secondary outcomes included postoperative biochemical indicators at 1 and 6 months after discharge [including fasting blood glucose (FBG), 2-hour postprandial blood glucose (2 h-PBG), alanine aminotransferase (ALT), serum creatinine (SCr), total bilirubin (TBil), blood urea nitrogen (BUN), and therapeutic drug concentrations], medication adherence [assessed by the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)], psychological status [measured by the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS)], and quality of life (evaluated using the GQOLI-74 questionnaire).</p><p><strong>Results: </strong>At both 1 and 6 months following discharge, patients in the intervention group demonstrated better biochemical outcomes, including lower FBG, 2 h-PBG, ALT, SCr, TBil, and BUN levels, as well as more stable drug concentrations compared with the control group (P < 0.05). Furthermore, ESCA scores, BAASIS scores, and GQOLI-74 scores were all higher in the intervention group than in the control group (P < 0.05). SDS and SAS scores were reduced in the intervention group relative to the control group (P < 0.05).</p><p><strong>Conclusion: </strong>The integration of a nursing care bundle with a clinical nursing pathway has a positive effect on improving self-management ability and medication adherence, optimizing postoperative biochemical indicators, alleviating negative emotions, and enhancing quality of life in liver transplant patients.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149269615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Handgrip strength and diameter-product-derived psoas area estimate in end-stage liver cirrhosis: an exploratory single-center analysis.","authors":"Eugen Malamutmann, Christina Neuhaus, Lale Umutlu, Sophia T Schmitz, Miroslav Jalc, Christian G Klein, Jan Bednarsch, Ulf Neumann, Arzu Oezcelik","doi":"10.1007/s00423-026-04150-y","DOIUrl":"10.1007/s00423-026-04150-y","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest that handgrip strength may correlate with muscle mass in cirrhosis, but validation across diverse transplant cohorts remains limited. We sought to validate whether previously reported correlations between handgrip strength and computed tomography (CT)-derived psoas-area estimates hold in a single-center cohort of liver transplant candidates and to explore whether a bedside prediction model could be derived.</p><p><strong>Methods: </strong>In this retrospective cohort study, 96 patients with end-stage liver cirrhosis undergoing transplant evaluation at University Hospital Essen (January 2020-December 2024) underwent standardized handgrip strength, 4-meter gait time, and diameter-product-derived psoas area estimates. Pearson correlation, multiple linear regression, and Cox proportional hazards analyses were performed with Benjamini-Hochberg correction for multiple comparisons.</p><p><strong>Results: </strong>Handgrip strength significantly correlated with total psoas area ([Formula: see text], 95% CI 0.16-0.51, [Formula: see text]). Multiple linear regression yielded a prediction model ([Formula: see text]) achieving 72% sensitivity and 68% specificity for sarcopenia detection (AUC = 0.74). In multivariate Cox regression, each 100 mm²/m² increase in psoas index reduced waiting list mortality by 15% (HR = 0.85, 95% CI 0.73-0.98, [Formula: see text]) and post-transplant mortality by 18% (HR = 0.82, 95% CI 0.71-0.95, [Formula: see text]).</p><p><strong>Conclusion: </strong>Handgrip strength shows a modest, statistically significant association with diameter-product-derived psoas area estimates in liver transplant candidates. The derived prediction model has limited accuracy ([Formula: see text], AUC = 0.74) and cannot defer clinically indicated CT imaging; it may assist in identifying candidates who warrant confirmatory imaging or closer nutritional follow-up.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine green fluorescence during total thyroidectomy: utility for predicting hypoparathyroidism and safety assessment.","authors":"Rasmus Reinke, Stefano Londero, Martin Almquist, Lars Rejnmark, Lars Rolighed","doi":"10.1007/s00423-026-04149-5","DOIUrl":"10.1007/s00423-026-04149-5","url":null,"abstract":"<p><strong>Purpose: </strong>Parathyroid fluorescence with indocyanine green (ICG) might prevent and predict postoperative hypoparathyroidism (hypoPT) after total thyroidectomy (TT). We aimed to evaluate parathyroid gland vascularization with ICG during TT. Further, we aimed to evaluate safety of ICG fluorescence and to correlate changes in PTH with postoperative hypoPT after TT.</p><p><strong>Methods: </strong>From May 2021 to June 2023, consecutive patients underwent TT and parathyroid fluorescence with ICG. Each visible parathyroid gland was scored 0, 1 or 2 depending on fluorescence intensity. Patients with at least one gland score of 2 were compared to those without. We measured PTH before and after TT, changes in calcium, creatinine and alanine transaminase (ALAT), postoperative alfacalcidol requirements, and adverse events of ICG use.</p><p><strong>Results: </strong>A total of 124 patients were included. Patients with at least one gland scored 2 (n = 108) had a reduced need for alfacalcidol at discharge compared with those without (8% vs. 38%, p = 0.004), although hypoPT was not fully excluded. Six patients required alfacalcidol after 12 months and were classified as having permanent hypoPT; all had an intraoperative PTH decrease > 83%. Creatinine levels were higher in patients with permanent hypoPT compared to others (p = 0.01). No increases in ALAT or ICG-related adverse events were observed.</p><p><strong>Conclusions: </strong>ICG-based parathyroid fluorescence during TT was well tolerated in this cohort and predicted immediate postoperative hypoPT. However, a fluorescence score of 2 did not exclude hypoPT development. The grading system is limited by subjectivity. No permanent hypoPT occurred in patients with a PTH decrease ≤ 83% after TT.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}