BMC Surgery最新文献

{"title":"Comparative analysis of the prognosis of fluid resuscitation in sepsis shock patients guided by radial artery applanation tonometry and critical care ultrasound: a retrospective cohort pilot study.","authors":"Xiaoqiang Bao, Qiuxiang Pan, Miaomiao Jiang, Lu Lu, Feng Li, Zhenhua Dong, Zhiheng Li","doi":"10.1186/s12893-025-03000-w","DOIUrl":"https://doi.org/10.1186/s12893-025-03000-w","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamic monitoring is crucial for guiding fluid resuscitation in patients with Septic shock (SS). Radial artery applanation tonometry (RAAT) is faster and easier to operate and has been developed and used for continuous arterial pressure monitoring. However, there is no empirical evidence to confirm its benefit in the treatment of SS. The aim of this study was to investigate the clinical efficacy of two non-invasive hemodynamic monitoring techniques, namely RAAT and critical care ultrasound (CCUS)-guided interventions, in the treatment of fluid resuscitation in SS.</p><p><strong>Methods: </strong>This single-center retrospective study included patients diagnosed with SS at our institution from 2021 to 2022. Patients were divided into two groups based on the hemodynamic monitoring method used: the RAAT group and the CCUS group. Twenty-eight-day mortality, intensive care unit (ICU) length of stay, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, incidence of renal failure, hemodynamic parameters, oxygenation index, Lac levels, Lac clearance, and procalcitoninogen (PCT) levels were assessed after fluid resuscitation in both groups.</p><p><strong>Results: </strong>A total of 78 patients were included in the study, with 41 in the RAAT group and 37 in the CCUS group. There were no significant differences in demographic and baseline characteristics between the two groups except for SOFA, heart rate, MAP. early outcomes including 28 day mortality, 48 h oxygenation index, PCT levels and Acute Physiology and Chronic Health Evaluation II score, ICU stay, infusion volume, and incidence of renal failure. There was no significant difference in metabolic and hemodynamic indexes of Lac, Lac clearance, CVP, and 48 h MAP, and there was a significant difference in 24 h MAP between the CCUS group [68 (65, 71)] and the RAAT group [71 (67, 75)], P = 0.008.</p><p><strong>Conclusion: </strong>In the fluid resuscitation of SS patients, the effects of the non-invasive hemodynamic monitoring methods RAAT and CCUS are comparable. In clinical application, the appropriate method can be selected according to the patient's specific situation, hospital resources, medical staff's proficiency and monitoring needs, or a combination of the two can be used in order to more comprehensively and accurately assess the patient's condition.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"262"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561681","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":"Comparing open surgical, SELDINGER'S technique with surgical isolation of the vein and ultrasound guided techniques for jugular central line insertion in infants: a randomized clinical trial.","authors":"Mohamed Mahmoud Salah Eldin, Sherif Mohamed K Shehata, Mohamed Ali Shehata, Ahmed Abdelmohimen Elhaddad","doi":"10.1186/s12893-025-02988-5","DOIUrl":"https://doi.org/10.1186/s12893-025-02988-5","url":null,"abstract":"<p><strong>Background: </strong>Centrally Inserted Central Catheter (CICC) placing procedure is challenging in the pediatric population, especially in newborns and infants, leading to lower success and higher complication rates than in adults. The aim of this study was to compare three approaches: open technique, SELDINGER'S technique with surgical isolation of the vein, and percutaneous ultrasound-guided CICC insertion for central line insertion in infancy as regards safety, success of cannulation, technique time, and preservation of the patency of the internal jugular vein (IJV).</p><p><strong>Methods: </strong>This prospective randomized cohort study was conducted after approval of the Ethical Committee of Tanta University Hospital with approval code: 36264MS38/1/23 (clinical trial ID: NCT06862492 and date: 03/05/2025). This study adheres to CONSORT guidelines. This study included 105 infants in need of CVC insertion over a period of 6 months. They were randomly allocated into three equal groups; group A underwent CICC insertion using the open surgical technique, group B underwent SELDINGER'S technique with surgical isolation of the vein, and group C underwent percutaneous ultrasound-guided CICC insertion.</p><p><strong>Results: </strong>Patency was significantly higher in SELDINGER'S technique with surgical isolation of the vein and percutaneous ultrasound-guided techniques compared to the open surgical technique (P = 0.003, < 0.001). There was a significant negative correlation between patency of IJV and duration of CICC placement (r = -0.238, P = 0.010) and with the number of trials to success of the cannulation (r = -0.252, P = 0.006). The technique time was significantly shorter in the percutaneous ultrasound-guided technique compared to open surgical and SELDINGER'S technique with surgical isolation of the vein (P < 0.001, < 0.001). SELDINGER'S technique with surgical isolation of the vein was a significantly shorter technique time when compared to the open surgical technique (P < 0.001).</p><p><strong>Conclusions: </strong>US-guided catheterization of the IJV shows more advantages in the form of a less time-consuming technique with a high first attempt and insertion success rate and fewer trials compared to CICC insertion using either open surgical technique or SELDINGER'S technique with surgical isolation of the vein.</p><p><strong>Trial registration: </strong>Current Controlled Trials NCT06862492 and date: 03/05/2025.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"280"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561682","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":"Factors associated with mortality in surgical patients admitted to a low-resource mixed intensive care unit: a cross-sectional study.","authors":"Jacques Fadhili Bake, Kambere Mukama Phalek, Mumbere Kigayi Jean-Pierre, Kasereka Masumbuko Claude","doi":"10.1186/s12893-025-03031-3","DOIUrl":"https://doi.org/10.1186/s12893-025-03031-3","url":null,"abstract":"<p><strong>Background: </strong>Providing critical care is essential for improving health outcomes, particularly in low-resource settings such as the Democratic Republic of the Congo (DRC). However, there is a significant lack of data regarding the management and outcomes of critically ill surgical patients in this region. This study aimed to investigate the factors associated with mortality among surgical patients admitted to the intensive care unit (ICU) at HEAL Africa Hospital in eastern DRC.</p><p><strong>Methods: </strong>This retrospective cross-sectional study analyzed data from surgical patients admitted to the ICU between January 2021 and June 2023. Information was extracted from the ICU registry, including demographics, reasons for admission, management details, length of stay, and mortality rates. Categorical data were presented as frequencies, and logistic regression was used, with a p-value of less than 0.05 considered significant.</p><p><strong>Results: </strong>Out of 807 patients admitted to the ICU, 368 were surgical patients (43.12%). The cohort had a male predominance (1.6:1) with a median age of 31 years. The primary reason for admission was postoperative monitoring (57.2%). The overall mortality rate was 21.3%. Univariate analysis identified statistically significant risk factors for increased mortality: male sex (p = 0.004), age (p = 0.0409), need for mechanical ventilation (p < 0.0001), involvement in neurosurgery (p = 0.03), and non-operative management (p < 0.0001). Multivariate analysis confirmed that the need for mechanical ventilation (p < 0.0001) and the non-operative management (p < 0.0001) was significantly associated with increased mortality.</p><p><strong>Conclusion: </strong>The burden of surgical critically ill patients in eastern DRC is substantial. Non-operative management and the requirement for mechanical ventilation were identified as factors influencing mortality among these patients. To tackle this pressing issue, it is essential to enhance critical care protocols, invest in the training of healthcare professionals, and allocate resources effectively.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"269"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561703","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":"Laparoscopic versus open resection for unfavorable sites gastric gastrointestinal stromal tumors: a propensity weighted cohort study.","authors":"Yang Zong, Yawei Qian, Jianghao Xu, Qingya Li, Linjun Wang, Li Yang, Hao Xu, Jianfeng Gu, Zekuan Xu","doi":"10.1186/s12893-025-02994-7","DOIUrl":"https://doi.org/10.1186/s12893-025-02994-7","url":null,"abstract":"<p><strong>Background and objectives: </strong>To compare the efficacy and feasibility of laparoscopic resection with those of open surgery for gastric gastrointestinal stromal tumors (GISTs) in unfavorable locations using the propensity score weighting (PSW) method.</p><p><strong>Methods: </strong>Clinicopathological and follow-up data from 170 patients found to have gastric GISTs in unfavorable locations from January 2017 to December 2021 were analyzed retrospectively. Among the 170 patients, 121 underwent laparoscopic surgery, and 49 underwent open surgery. The PSW was used to create balanced cohorts and adjusted for six clinically validated covariates: sex, age, BMI, tumor size, mitotic rate, and recurrence risk.</p><p><strong>Results: </strong>After PSW, 325.2 patients, consisting of 167 laparoscopic (Lap group) and 158.2 open surgery (Open group) patients, were matched. The Lap group had shorter operation times (84.7 ± 37.7 min versus 123.4 ± 46.9 min, P < 0.001) and shorter hospital stays (7.0 [5.0, 8.0] days versus 9.0 [8.0, 11.0] days, P < 0.001) than the Open group. Although the Open group exhibited a numerically higher complication rate (10.24% vs. 4.97%), this difference did not reach statistical significance (P = 0.243). Moreover, no significant differences existed in recurrence-free survival or overall survival.</p><p><strong>Conclusions: </strong>Laparoscopic surgery is safe and feasible for gastric GISTs in unfavorable locations. Compared with open surgery, laparoscopic resection facilitates faster postoperative recovery and has a similar long-term prognosis.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"274"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561716","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":"Minimally invasive myofascial closure device in combination with laparoscopy for pediatric linea alba hernia repair: a new approach.","authors":"Hong Zhang, Yuanyuan Luo, Jixiao Zeng, Fei Liu, Menglong Lan, Zhihua Ye, Boyuan Tao, Lini Wen, Xiaogang Xu","doi":"10.1186/s12893-025-03023-3","DOIUrl":"https://doi.org/10.1186/s12893-025-03023-3","url":null,"abstract":"","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"275"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561718","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":"Predictors of return-to-work after thyroid cancer surgery based on random forest model: a cross-sectional study.","authors":"Xiaoxia Tang, Xiaolin Yi, Huina Mao, Mei Wang, Rui Chen, Aoxue Zhu","doi":"10.1186/s12893-025-02901-0","DOIUrl":"https://doi.org/10.1186/s12893-025-02901-0","url":null,"abstract":"<p><strong>Background: </strong>Thyroid cancer (TC) is the most prevalent malignancy among middle-aged and young adults. Many patients will face the challenge of return-to-work (RTW) after TC surgery. If patients cannot return to work successfully, it may affect their social recovery and quality of life. This study used the random forest algorithm to identify the predictors of RTW after TC surgery.</p><p><strong>Methods: </strong>A cross-sectional study was conducted, encompassing a sample of 242 patients who underwent TC surgery in Zhujiang Hospital of Southern Medical University from April to December 2023. The participants completed questionnaires including the general information questionnaire, the Return-To-Work Self-Efficacy Questionnaire (RTW-SE), the Cancer Fatigue Scale (CFS), and the Vancouver Scar Scale (VSS). In this study, the predictors of RTW after TC surgery were analyzed by univariate analysis, multiple logistic regression, and random forest model (RFM).</p><p><strong>Results: </strong>The final 229 TC patients were included in this study, of which 183 (79.9%) returned to work, of which 46 (20.1%) failed to return to work. The median time of RTW was 30.00(14.00, 33.75) days after TC surgery. The RFM indicated that RTW-SE was a key predictor related to RTW after TC surgery and other predictors were ranked in order of importance as follows: postoperative time, neck scar (NS), medical insurance, complications, and rehabilitation exercise.</p><p><strong>Conclusions: </strong>20.1% (46/229) of patients still failed to return to work after TC surgery. Healthcare professionals ought to emphasize the importance of modifiable factors, improving TC patients' RTW-SE, reducing the formation of NS, minimizing the occurrence of complications, and promoting rehabilitation exercise may help to facilitate RTW after TC surgery.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"253"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561720","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":"Robotic-assisted vs. traditional medial patellofemoral ligament reconstruction: a comparative study of surgical precision and clinical outcomes.","authors":"Hongzhi Fang, Zhenghui Shang, Tianli Du","doi":"10.1186/s12893-025-03012-6","DOIUrl":"https://doi.org/10.1186/s12893-025-03012-6","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the feasibility and clinical effectiveness of reconstructing the Medial Patellofemoral Ligament (MPFL) using robotic-assisted reconstruction.</p><p><strong>Methods: </strong>This retrospective cohort study encompassed 46 patients who underwent medial patellofemoral ligament reconstruction at Yichang People's Hospital between January 2022 and January 2024. Patients were categorized into a conventional surgery group (control group, n = 24) and a robot-assisted surgery group (experimental group, n = 22) based on whether robotic assistance was used during the procedure. The primary endpoints included the error margin between the femoral tunnel entry point, a predefined reference landmark, and the quantity of intraoperative fluoroscopic exposures. Secondary endpoints consisted of knee function scores at postoperative and final follow-up evaluations, patellar stability, operative duration, length of hospital stay, and intraoperative blood loss.</p><p><strong>Results: </strong>The experimental group demonstrated a significantly higher degree of precision in femoral tunnel placement than the control group, as indicated by a smaller mean distance from the tunnel entry point to the reference landmark (P < 0.05). Additionally, the experimental group markedly reduced intraoperative fluoroscopic exposures relative to the control group (P < 0.05). No significant differences were observed between the two groups regarding postoperative or final follow-up patellar stability or knee function scores (P > 0.05). Furthermore, the experimental group incurred significantly shorter hospital stays and experienced less intraoperative blood loss than the control group (P < 0.05). At the same time, the operative time did not present any significant differences between groups (P > 0.05).</p><p><strong>Conclusion: </strong>Robot-assisted MPFL reconstruction significantly enhances femoral tunnel positioning accuracy and surgical efficiency compared to conventional methods. This approach offers a promising surgical option for improving precision and efficiency in the management of recurrent patellar dislocation, with potential implications for future research.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"276"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561721","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":"Analysis of the effects of MIPPO under the anterolateral approach on stress indicators and ankle joint function in patients with open fracture of tibia and fibula.","authors":"Zhihua Wang, Peipei Xu, Junjun Liao","doi":"10.1186/s12893-025-03030-4","DOIUrl":"https://doi.org/10.1186/s12893-025-03030-4","url":null,"abstract":"","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"273"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561654","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":"Comparative analysis of extraperitoneal versus transabdominal cesarean sections: a meta-analysis of randomized controlled trials and systematic review.","authors":"Mengmeng Jia, Guangquan Ji, Ruifang Wang, Zhen Yan, Wei Niu, Jian Chen, Juanjuan Yu","doi":"10.1186/s12893-025-02981-y","DOIUrl":"https://doi.org/10.1186/s12893-025-02981-y","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to systematically evaluate the efficacy of Extraperitoneal Cesarean Section (ECS) compared to Transabdominal Cesarean Section (TCS) in pregnant women, and to assess the differences in treatment outcomes between the two surgical approaches.</p><p><strong>Approach and techniques: </strong>We conducted an extensive literature search, pulling up the most recent findings from reputable sources like the Cochrane Library, PubMed, EMBASE, Google Scholar, and Web of Science, all the way up to October 2024. Our meta-analysis comprised seven randomized controlled trials. We followed a fixed-effects model for results with less heterogeneity and a random-effects model for those with more. We utilized Stata 18 to conduct data analysis. For continuous data, we computed weighted mean differences (WMD). For categorical data, we calculated odds ratios (OR). We also included 95% confidence intervals (CI) with all of our results. We also used the Cochrane Risk of Bias tool to check all of the randomized controlled trials (RCTs) for bias.</p><p><strong>Results: </strong>This meta-analysis did not find any statistically significant differences between the two groups when it came to baseline factors such as Body Mass Index (BMI), gestational week, and history of cesarean section. Statistical analysis revealed no significant differences in surgical outcomes (i.e., time to delivery(WMD 2.25, 95% CI -0.29 to 4.79, p = 0.083), time to operation (WMD 3.11, 95% CI -2.96 to 9.18, p = 0.316), neonatal weight (WMD -62.25, 95% CI -152.37 to 27.87, p = 0.176), 1-min Apgar score (WMD 0.03, 95% CI -0.39 to 0.45, p = 0.897), 5-min Apgar score (WMD 0.09, 95% CI -0.07 to 0.24, p = 0.296), blood loss (WMD 36.41, 95% CI -21.51 to 94.32, p = 0.218), etc.) between the TCS and ECS groups. However, the ECS group had a significantly shorter hospital stay (WMD -0.51, 95% CI -0.89 to -0.13, p=0.009) and less reduction in hemoglobin level (WMD -0.23, 95% CI -0.39 to -0.07, p=0.004) compared to TCS.</p><p><strong>Conclusion: </strong>To sum up, this meta-analysis shows that ECS may help with postoperative hemoglobin level changes and shortening hospital stays. ECS may improve recovery metrics without adversely affecting maternal or neonatal outcomes. This analysis provides valuable insights that can guide clinical decision-making, even though there was no statistically significant difference between the two surgical approaches in terms of delivery time, operative time, neonatal weight, Apgar scores, or blood loss.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"266"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561680","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":"Comparison of different treatments for lumbar disc herniation: a network meta-analysis and systematic review.","authors":"Ke Song, Jie Liang, Meiling Zhang, Songlin Cai, Yanfei Wang, Weifei Wu","doi":"10.1186/s12893-025-02992-9","DOIUrl":"https://doi.org/10.1186/s12893-025-02992-9","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation (LDH) is a prevalent spinal disorder that imposes substantial health burdens in the form of chronic pain and mobility limitations, particularly in working-age populations. Due to advancements in technology and materials, the treatments for LDH are constantly being updated.</p><p><strong>Purpose: </strong>The purpose of this systematic review and network meta-analysis (NMA) was to compare the outcomes of different LDH treatments.</p><p><strong>Study design: </strong>A NMA of randomized controlled trials (RCTs) comparing various treatments for LDH.</p><p><strong>Methods: </strong>This review was conducted in accordance with to the PRISMA-P guidelines. The PubMed, Embase, Medline, and Cochrane Library electronic databases were systematically searched from 2007 to March 2024 to identify RCTs comparing various treatments for LDH. The outcomes of interest included changes in the pain score, disability score and recurrence rate at the one-year follow-up. The risk of bias among the included studies was assessed using the Cochrane method. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was tailored for network meta-analysis and used to evaluate the overall certainty of the evidence regarding each outcome. This study employed a frequentist approach to conduct the NMA, and all procedures were carried out using the network package in Stata 14.2. The PROSPERO number was CRD42024578677.</p><p><strong>Results: </strong>Twenty-seven RCTs involving 4633 participants and seven treatment strategies were included. Compared with conservative treatments, all surgical interventions demonstrated better efficacy in pain relief and disability recovery. Among the surgical options, endoscopic discectomy with internal fixation (EDF), percutaneous endoscopic discectomy (PED), microdiscectomy (MD) and open discectomy (OD) were found to be significantly superior to conservative treatments, with EDF showing the best performance. Surface under the cumulative ranking curve (SUCRA) plots displayed the same trend as the NMA results. No significant differences were observed in terms of recurrence rates. However, the SUCRA plots indicated that EDF ranked best in terms of recurrence rates. The GRADE assessment revealed that the quality of most of the evidence was low or very low.</p><p><strong>Conclusion: </strong>The implantation of internal fixation devices was shown to have no impact on quality of life. EDF appears highly effective, especially for pain relief, but other less invasive options, such as PED, have similarly good outcomes in many respects.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"259"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561683","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}