Updates in Surgery最新文献

{"title":"Intrahepatic ductoplasty effectively corrects the ductal dilatation in Todani type IV-A choledochal cyst in children.","authors":"Tong Yin, Wei Liu, Suyun Chen, Mei Diao, Long Li","doi":"10.1007/s13304-025-02147-8","DOIUrl":"10.1007/s13304-025-02147-8","url":null,"abstract":"<p><p>Primary ductal stricture and intrahepatic duct dilatation are characteristic features in Todani type IV-A choledochal cysts (CDC) and necessitate thorough evaluation and management during surgical treatment. This study aimed to present our experience with ductoplasties for type IV-A CDCs with primary ductal strictures. Between June 2015 and June 2022, 54 patients were reviewed. Primary ductal strictures were identified, and ductoplasties were performed individually. The demographic characteristics, imaging examinations, postoperative outcomes, and complications were evaluated. Among enrolled patients, 36 (66.66%) had strictures at the exit of the common hepatic duct (CHD), 13 (24.07%) had strictures at the exit of the left hepatic duct (LHD) and/or right hepatic duct (RHD), 4 (7.41%) had strictures at the exit of the CHD, with LHD and/or RHD, and 1 (1.85%) patient had strictures at the level 2 or more intrahepatic biliary duct. The median follow-up period was 5.20 years. The dilated intrahepatic ducts returning to a normal size occurred in 52 (96.30%) patients. Two (3.70%) patients experienced anastomosis leakage and required surgical repair 3 ~ 5 days later. Liver function normalized within 1 year postoperatively. It is safe and effective to perform ductoplasties for primary ductal strictures in Todani type IV-A CDCs.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"471-480"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567888","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":"The effect of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration in treatment of cholecystolithiasis combined with choledocholithiasis.","authors":"Song Xu, Chuanmin Deng, Kaikai Tang, Gang Nian, Zhongran Man, Song Yang, Ming Xu","doi":"10.1007/s13304-025-02110-7","DOIUrl":"10.1007/s13304-025-02110-7","url":null,"abstract":"<p><p>This study aims to compare the efficacy of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic common bile duct exploration (LCBDE), and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of gallbladder stones with common bile duct stones. We conducted a retrospective comparative analysis based on surgical time, intraoperative blood loss, postoperative recovery metrics, total hospitalization costs, gastrointestinal quality of life index (GIQLI) before and after surgery, and the incidence of postoperative complications. No significant differences were found among the three groups in terms of the surgical success rate, first stone clearance rate, intraoperative blood loss, incidence of postoperative complications, and stone recurrence rate (p > 0.05). The LTCBDE group had shorter surgical time, earlier time to get out of bed, earlier first flatus time, shorter postoperative hospital stays, and earlier removal of abdominal drainage tube compared to the LCBDE and the ERCP + LC groups (all p < 0.05). The average hospitalization cost was also lower in the LTCBDE group (p < 0.05). LTCBDE for the treatment of gallbladder stones with common bile duct stones leads to faster recovery and improved quality of life. It is safe and effective, making it a method worthy of promotion.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"493-499"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042396","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":"Correlation between parathyroid adenoma volume and perioperative outcomes in primary hyperparathyroidism: Does the size matter?","authors":"Antonio Fiore, Sophie Eschlböck, Céline Carlen, Ioannis I Lazaridis, Alexandros Lalos, Raoul Droeser, Tarik Delko, Alberto Posabella","doi":"10.1007/s13304-025-02086-4","DOIUrl":"10.1007/s13304-025-02086-4","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperparathyroidism (PHPT) due to a parathyroid adenoma stands as one of the most prevalent endocrinological disorders, with focused parathyroidectomy being the established therapeutic strategy.</p><p><strong>Aim: </strong>This study aims to investigate whether the volume of the pathological gland influences perioperative outcomes and postoperative morbidity.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from 141 patients who underwent focused parathyroidectomy for PHPT at the University Hospital of Basel between 2007 and 2022.</p><p><strong>Results: </strong>A total of 141 patients underwent surgery, with a mean age of 57.2 years and prevalence of women (64.5%).The volume of the lesion was divided into three groups (low < 1 ml, middle 1-1.99 ml, large > 2 ml) based on pathological specimen analysis. Preoperative calcium and parathyroid hormone (PTH) values were significantly higher in the large volume group compared to the low volume group (p < 0.05), while phosphate and vitamin D values were significantly lower (p < 0.05). A comparison of adenoma volume in symptomatic patients with asymptomatic patients revealed no statistically significant difference (p = 0.845) and the volume of the gland of any group did not influence the length of the operation (p = 0.173) and the perioperative morbidity (p = 0.108).</p><p><strong>Conclusion: </strong>Compared to a volume of less than 1 ml, a parathyroid gland volume greater than 2 ml was associated with higher preoperative PTH and calcium levels and lower phosphate and vitamin D levels. The volume of the parathyroid gland does not seem to impact the clinical manifestations, or the incidence of perioperative complications.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"381-388"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068165","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":"The implementation of eras in Belgian esophageal surgery centers.","authors":"Yaliva Dorreman, Hanne Vanommeslaeghe, Piet Pattyn, Claude Bertrand, Lieven Depypere, Hans Van Veer, Philippe Nafteux, Yves Van Nieuwenhove, Elke Van Daele","doi":"10.1007/s13304-025-02063-x","DOIUrl":"10.1007/s13304-025-02063-x","url":null,"abstract":"<p><p>Esophagectomy for cancer is a highly invasive procedure with significant post-operative morbidity and mortality. The literature suggests a clear volume outcome correlation. Since 2019, esophageal surgery has been centralized in Belgium. In 2019, enhanced recovery after surgery (ERAS) guidelines were published for esophagectomy. The purpose of this study was to evaluate the level of implementation of these ERAS guidelines in Belgium. Surgeons from centralized esophageal surgery centers in Belgium were questioned. A Delphi questionnaire regarding peri-operative ERAS care and center-specific outcome data were sent to all participating surgeons. An ERAS scoring system was created to estimate and compare the level of ERAS implementation. Length of stay, post-operative pneumonia, anastomotic leakage and 30-day and 90-day mortality were evaluated. A high response rate of 94.1% was achieved. All surgeons used a peri-operative protocol in their center. The mean ERAS score for Belgian surgeons was 15.5 out of 20. The highest ERAS score per center is 18.6. Anastomotic leakage rate is 14.6% and post-operative pneumonia rate is 20.8% in Belgium. The mean length of stay is 12 days. Mortality after 30 days and 90 days are, respectively, 3.2% and 6.6%. This study gives an overview of the Belgian situation regarding the implementation of ERAS protocols in esophageal surgery centers. The overall implementation of ERAS guidelines in Belgium is good, but there is room for improvement in terms of uniformity nationally.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"411-418"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374824","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":"Statistical models versus machine learning approach for competing risks in proctological surgery.","authors":"Lucia Romano, Andrea Manno, Fabrizio Rossi, Francesco Masedu, Margherita Attanasio, Fabio Vistoli, Antonio Giuliani","doi":"10.1007/s13304-025-02109-0","DOIUrl":"10.1007/s13304-025-02109-0","url":null,"abstract":"<p><p>Clinical risk prediction models are ubiquitous in many surgical domains. The traditional approach to develop these models involves the use of regression analysis. Machine learning algorithms are gaining in popularity as an alternative approach for prediction and classification problems. They can detect non-linear relationships between independent and dependent variables and incorporate many of them. In our work, we aimed to investigate the potential role of machine learning versus classical logistic regression for the preoperative risk assessment in proctological surgery. We used clinical data from a nationwide audit: the database consisted of 1510 patients affected by Goligher's grade III hemorrhoidal disease who underwent elective surgery. We collected anthropometric, clinical, and surgical data and we considered ten predictors to evaluate model-predictive performance. The clinical outcome was the complication rate evaluated at 30-day follow-up. Logistic regression and three machine learning techniques (Decision Tree, Support Vector Machine, Extreme Gradient Boosting) were compared in terms of area under the curve, balanced accuracy, sensitivity, and specificity. In our setting, machine learning and logistic regression models reached an equivalent predictive performance. Regarding the relative importance of the input features, all models agreed in identifying the most important factor. Combining and comparing statistical analysis and machine learning approaches in clinical field should be a common ambition, focused on improving and expanding interdisciplinary cooperation.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"333-341"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042394","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":"How has the diagnostic approach to parathyroid localization techniques evolved in the past decade? Insights from a single-center experience.","authors":"Giuseppe Cacciatore, Manuela Mastronardi, Lucia Paiano, Hussein Abdallah, Carmelo Crisafulli, Franca Dore, Stella Bernardi, Nicolò de Manzini, Margherita Sandano, Chiara Dobrinja","doi":"10.1007/s13304-025-02090-8","DOIUrl":"10.1007/s13304-025-02090-8","url":null,"abstract":"<p><p>The standardization of preoperative imaging in primary hyperparathyroidism is one of the current challenges of endocrine surgery. A correct localization of the hypersecretory gland by neck ultrasound and 99mTc-sestamibi (MIBI) scintigraphy are not sufficiently sensitive in some cases. In recent years, CT-4D, 18F-Fluorocholine PET/CT, and radio-guided parathyroidectomy have come into common use. The aim of this study is to evaluate the performance of 18F-Fluorocholine PET/CT after prior negative or discordant first-line imaging in patients with primary hyperparathyroidism undergoing parathyroid surgery. Monocentric observational study on patients affected by pHPT undergoing surgery from July 2009 to April 2024 at the Division of General Surgery, Cattinara Teaching Hospital of Trieste. Preoperative, intra-operative, and follow-up data were collected. The imaging methods used were neck ultrasound, 99mTc-sestamibi (MIBI) scintigraphy, and 18F-Fluorocholine PET/CT (since 2018). 172 patients were included. As first radiologic examination, neck ultrasound (US) was performed in 140 cases and 99mTc-sestamibi (MIBI) scintigraphy in 162. Ultrasound and/or scintigraphy imaging were sufficient for the identification of the gland in 127 patients (73.8%), while in 45 patients (26.2%), the localization was defined with other techniques. Particularly, three patients with negative or discordant first-line imaging underwent neck 4D-CT scan who was useful for parathyroid localization all cases (100%). Only one patient received a neck magnetic resonance (MRI) and resulted positive for preoperative localization. Starting in 2018, 29 out of 45 patients underwent 18F-FCH PET/CT yielding a positive result in 29 patients (100%). In other 16 cases (before the introduction of PET/CT in our preoperative imaging study), the preoperative localization was inconclusive and bilateral neck exploration (BNE) was necessary. The sample was homogeneous in terms of age, anthropometric characteristics, and preoperative biochemical parameters. Male/female ratio was 1:5.1. In the intra-operative site, in the cases of exclusive PET/CT positivity, in 28 cases (96.5%), a diagnostic agreement was confirmed, and the gland was macroscopically smaller or normal in size. The combination of ultrasound and MIBI scintigraphy remains the preferred imaging approach for preoperative studies of pHPT. If secondary imaging is required, 18F -FCH PET/CT stands out as the most advantageous option due to its ability to provide anatomical and functional specificity. FCH PET/CT resulted an effective imaging modality with the highest sensitivity of the available imaging techniques for localizing the hyperfunctioning parathyroid gland. Therefore, this method can be recommended in patients showing negative or inconclusive results in the conventional diagnostic imaging.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"389-399"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012141","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":"Enhanced recovery after surgery (ERAS) in stoma reversal surgery: a systematic review and meta-analysis.","authors":"Túlio Pimentel, Dante L S Souza, Ivonne Zuniga, Maria Clara Faveri, Julia Canfild, Paula Motta Pauperio, Hamza Guend","doi":"10.1007/s13304-025-02092-6","DOIUrl":"10.1007/s13304-025-02092-6","url":null,"abstract":"<p><p>Stoma reversal surgery is known for relatively high complication rates. While Enhanced Recovery After Surgery (ERAS) protocols are extensively validated for colorectal surgery, their use in stoma reversal remains underexplored. This systematic review and meta-analysis evaluates clinical outcomes of stoma reversal surgery under ERAS protocols compared to standard care (SC) practices. Medline, EMBASE, and Cochrane Central databases were searched for studies that compared clinical outcomes of stoma reversal surgery under ERAS protocols versus SC practices. The endpoints of interest were length of stay (LOS), ileus, wound infection, anastomotic leak, time to first stool, overall, minor, and major postoperative complications, readmission rates, and reoperation rates. Mean difference (MD) was calculated for continuous variables and Odds Ratio (OR) for dichotomous variables. Statistical analysis was performed with R version 4.4.0. We included eight studies comprising 1322 patients. Among these, 603 (45.6%) followed an ERAS protocol, while 719 (54.4%) received SC practices. ERAS was associated with a significant decrease in LOS (MD -1.83; 95% CI -2.55 to -1.12; p < 0.01), wound infection (OR 0.47; 95% CI 0.23 to 0.97; p = 0.041), and time to first stool (MD -1.02; 95% CI -1.22 to -0.81; p < 0.01). No statistically significant difference was observed regarding ileus, anastomotic leak, overall, minor, and major postoperative complications, readmission rates, or reoperation rates. The implementation of ERAS protocols in stoma reversal procedures should be considered, as it was associated with a shorter length of hospital stay without increasing morbidity, and may even reduce complications such as wound infections.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"297-307"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972251","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":"Implications of robotic platforms for repeat hepatectomies: a propensity score matched study of clinical outcomes.","authors":"Bhavya Bansal, Tara M Pattilachan, Sharona Ross, Maria Christodoulou, Iswanto Sucandy","doi":"10.1007/s13304-025-02117-0","DOIUrl":"10.1007/s13304-025-02117-0","url":null,"abstract":"<p><p>Robotic surgical approaches have demonstrated improved outcomes in primary hepatectomies. However, data on their effectiveness in redo hepatectomies (subsequent liver resections) are limited. This study aims to compare the outcomes of patients undergoing primary and redo robotic hepatectomies, with additional analysis comparing outcomes of robotic versus open redo hepatectomies. With IRB approval, we prospectively followed 101 patients from a parent population of 465, who were classified as either primary (non-redo) or redo robotic hepatectomy patients between 2013 and 2023. A Propensity Score Matched (PSM) analysis was conducted to compare perioperative variables between the two cohorts, using age, sex, BMI, IWATE score, tumor size, and tumor type as matching variables. Data are presented as median (mean ± standard deviation). Significance was accepted at p ≤ 0.05. After 3:1 PSM analysis (3 primary patients to 1 robotic redo patient), no significant differences were observed in pre-, intra-, or postoperative variables, except for the Model for End-Stage Liver Disease (MELD) score (p = 0.022). Additional analysis comparing robotic and open redo hepatectomies showed similar perioperative outcomes, with the robotic approach demonstrating comparable safety and feasibility. Length of stay, blood loss, operative duration, morbidity, and mortality showed no significant differences between the two groups. Major complications (Clavien-Dindo score ≥ III) occurred in 4% of non-redo patients, with none observed in the redo group. The findings suggest that patients undergoing redo robotic hepatectomies achieve outcomes comparable to those of primary hepatectomy patients. This indicates the potential of robotic platforms to mitigate the added complexities and risks associated with redo hepatectomies. Further multi-center collaboration is necessary to validate these findings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"447-454"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410749","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":"Use of risk assessment tools in emergency general surgery: a cross-sectional survey of surgeons and trainees.","authors":"Andrea Spota, Amir Hassanpour, David Gomez, Eisar Al-Sukhni","doi":"10.1007/s13304-025-02089-1","DOIUrl":"10.1007/s13304-025-02089-1","url":null,"abstract":"<p><p>The applicability of risk assessment tools (RATs) for preoperative risk assessment (PRA) in Emergency General Surgery (EGS) is unclear. Limited knowledge of surgeons' approach to risk assessment is available. We investigated how Canadian surgeons approach PRA for EGS and their awareness of available RATs. Canadian Association of General Surgeons members were invited to complete an online cross-sectional survey. Descriptive statistics were reported. Of 278 respondents, 70% were attending surgeons (44% had 5-10 years in practice, 43% > 10 years), 5% fellows, and 25% residents. Most worked in medium-/large-volume centers (89%) and teaching hospitals (77%). During preoperative risk assessment, 2/3 of respondents reported applying clinical experience/instinct and referring to literature, while 55% used RATs. The best-known and used tools were the ACS-NSQIP calculator (68% and 59%) and the Emergency Surgery Acuity Score (ESAS, 66% and 47%, respectively). Surgeons were divided regarding the accuracy of RAT estimates, with 47% considering them generally accurate and 49% inaccurate. Trainees reported greater interest in major morbidity risk (86% vs. 65%) and probability of supported discharge (45% vs. 29%) than surgeons. Among participants not using RATs, 41% indicated they are scarcely accessible in the EGS context, while 33% found them cumbersome and time-consuming. RATs are underused in favor of personal judgment. The use of RATs may facilitate decision-making in elderly/complex patients and help reduce variability in practice, particularly for trainees and less-experienced surgeons. A greater effort in education is needed to spread the culture of RATs for PRA.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"605-613"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012363","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":"Effects of NUSS surgery on degree of flat thoracic cage, cardiopulmonary function, and bone metabolism in pectus excavatum patients of different ages.","authors":"Fang Yue, Fan Yang, Zhiguo Chen, Lin Zhao, Zhenlei Jia","doi":"10.1007/s13304-024-02030-y","DOIUrl":"10.1007/s13304-024-02030-y","url":null,"abstract":"<p><p>This study was to explore the degree of flat thoracic cage (FTC), cardiopulmonary function, and bone metabolism of pectus excavatum (PE) children of different ages after NUSS surgery. A retrospective analysis was conducted on 90 children with PE who underwent minimally invasive pectus excavatum correction surgery (NUSS), divided into three age groups: group I (1-3 years), group II (3-6 years), and group III (6-12 years), with 30 patients in each group. The study compared differences in thoracic flattening index, surgical-related metrics, pulmonary function, peripheral blood levels of alkaline phosphatase (ALP), calcium, magnesium, zinc, and phosphorus, and complication rates among the groups. Preoperative ALP level increased with aging of the children (P < 0.05). After surgery, the FTC index and ALP level of all the three groups greatly decreased, but increased with aging (P < 0.05). The operating time, intraoperative blood loss, and postoperative duration of analgesia also showed a trend of group III > group II > group I (P < 0.05). Postoperative levels of pulmonary function, including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), maximum expiratory flow at 75% of vital capacity (MEF75), maximum expiratory flow at 50% of vital capacity (MEF50), maximum expiratory flow at 25% of vital capacity (MEF25), and maximal mid-expiratory flow (MMEF), were significantly higher than preoperative levels in group I (P < 0.05); but without significant changes in groups II and III (P > 0.05). Neglectable differences were found in peripheral blood Ca, Mg, Zn, and P levels before and after surgery and postoperative complications in three groups (P > 0.05). The degree of FTC worsened with aging; the younger the children receiving NUSS surgery are, the more obvious the improvement of postoperative PF.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"549-557"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791782","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}