European Journal of Pediatric Surgery最新文献

{"title":"Medical Costs of Patients Undergoing Esophageal Atresia Repair are Mainly Influenced by Associated Malformations.","authors":"Nicolas Pardey, Jan Zeidler, Jochen Blaser, Nastassja Becker, Jens Dingemann, Benno Ure, Nagoud Schukfeh","doi":"10.1055/a-2422-3247","DOIUrl":"10.1055/a-2422-3247","url":null,"abstract":"<p><strong>Background: </strong> Esophageal atresia (EA) is a rare disease requiring surgical repair, usually within the first days of life. Patients with EA require intensive postoperative care and often have comorbidities. There is a lack of data on the costs incurred by patients with EA during the first year of life.</p><p><strong>Methods: </strong> Anonymized claims data were provided by the Techniker Krankenkasse (∼10.8 million clients). Data were extracted for patients who had an inpatient diagnosis of EA (International Classification of Diseases [ICD]: Q39.0 or Q39.1) and a reconstruction of the esophageal passage in case of atresia (Operationen-und Prozedurenschlüssel [German version of ICPM, International Classification of Procedures in Medicine; OPS] 5-428.0 to 5-428.7, 5-316.1 or 5-431.0) during their first hospital stay. All patients were in their first year of life at initial hospitalization (2016-2020) and were followed up for 1 year. Costs, length of hospital stay, and duration of mechanical ventilation and differentiated OPS services were analyzed using descriptive statistics. Multiple linear regression was used to analyze the determinants of hospital costs.</p><p><strong>Results: </strong> A total of 119 patients with EA were included (55.5% male). The mean cost of the 1-year observation period was €89,736 ± 97,419 (range €12,755-640,154). The increasing costs of the initial hospitalization led to a disproportionate increase in the costs of the 1-year observation period. The presence of an associated malformation combined with surgical complications was associated with almost five-fold higher costs than in patients without an associated malformation and an uncomplicated course (€193,103 ± 157,507 vs. €39,846 ± 33,473). The mean duration of mechanical ventilation was 23.2 ± 43.1 days and the mean length of hospital stay was 80.3 ± 77.2 days.</p><p><strong>Conclusion: </strong> To our knowledge, this is the first study to investigate the costs of EA patients in the first year of life. The presence of an associated malformation combined with surgical complications was associated with almost five-fold higher costs than in patients without an associated malformation and an uncomplicated course.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"43-51"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333421","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 Outcomes of Single-Stage versus Two-Stage Laparoscopic Fowler-Stephens Orchidopexy: A Systematic Review snd Meta-Analysis.","authors":"Adrian Chi Heng Fung, Jaime Tze Wing Tsang, Ling Leung, Ivy Hau Yee Chan, Kenneth Kak Yuen Wong","doi":"10.1055/a-2375-9784","DOIUrl":"10.1055/a-2375-9784","url":null,"abstract":"<p><strong>Introduction: </strong> Intra-abdominal testis (IAT) remains a challenging and controversial subset within the management of cryptorchidism. While Fowler-Stephens orchidopexy (FSO) is still being advocated as the gold standard for the treatment of this entity, there is new and conflicting evidence on the comparative outcomes between single- or two-stage laparoscopic FSO (LFSO). The aim of the study is to investigate whether staging has benefits in children receiving LFSO.</p><p><strong>Methods: </strong> We searched the PubMed, Medline, Embase, and Cochrane Trials databases for studies comparing single- with two-stage LFSO in children from January 1, 1995 to December 31, 2023. We assessed the identified studies for quality and performed a systematic review and meta-analysis in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses. The main outcome measures examined were success rate (in terms of the scrotal position of the testis) and testicular atrophy, which were analyzed using fixed effect models.</p><p><strong>Results: </strong> We included 17 eligible studies that involved a total of 499 operated testes. The overall success rates of single- and two-stage LFSO were 79.4 and 90.3%, respectively. The overall testicular atrophy rates of single- and two-stage LFSO were 17.3 and 11%, respectively. Fixed effect model analysis showed that two-stage LFSO is significantly superior to single-stage LFSO in overall success rate (odds ratio [OR: 2.57]; 95% confidence interval [CI]: 1.50-4.39, <i>p</i> = 0.0006) and testicular atrophy rate (OR: 0.48; 95% CI: 0.28-0.79, <i>p</i> = 0.004). There is no heterogeneity in the reports, and the funnel plot showed no publication bias.</p><p><strong>Conclusions: </strong> Two-stage LFSO remains the first choice of operation for children with a high IAT, with a significantly higher success rate and a lower testicular atrophy rate.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"28-35"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857271","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":"Rethinking Fistula Preservation in Anorectal Malformation Surgery: A Histopathological Perspective.","authors":"Preeti Agarwal, Shubhajeet Roy, Anand Pandey, Nirpex Tyagi, Nitin Pant, Piyush Kumar, Jiledar Rawat","doi":"10.1055/a-2389-7550","DOIUrl":"10.1055/a-2389-7550","url":null,"abstract":"<p><strong>Objective: </strong> This study aims to assess the histopathological characteristics of the fistulous tissue in males with anorectal malformation (ARM) to determine its suitability for use in constructing a neoanus.</p><p><strong>Methods: </strong> This prospective observational study included male ARM patients with recto-urethral fistula. All other types were excluded. The tissue specimens comprised 0.5 to 2.0 cm of the most distal part of the rectal pouch and the fistulous tissue. Hematoxylin and eosin-stained sections were prepared. Histological features, viz. internal sphincter, anal grand and crypts, ganglion cells, presence of subepithelial fibrosis, thickened nerve trunks, and metaplasia, were evaluated.</p><p><strong>Results: </strong> Of 65 patients of ARM admitted, 24 met the inclusion criteria. Gross and microscopic internal sphincter was not found in any sample. The anal mucosa was visualized in all samples; however, crypts were irregular and distorted architecture was seen in 4 (16.67%) samples. Urothelial metaplasia was identified in 10 (41.67%) samples. Adequate ganglion cells were seen only in 6 (25%) samples. Significant submucosal fibrosis was seen in all samples. Thickened nerve trunks were identified in 4 (16.67%) samples.</p><p><strong>Conclusions: </strong> All normal anal histological features could not be found together in the fistula tissue. With the absence of normal features, such as internal anal sphincter muscles, and the presence of abnormal histopathological features, such as subepithelial fibrosis, thickened nerve trunks, and metaplasia, there are high chances of abnormal bowel function like constipation if the fistulous tissue is used for neoanus construction. It may have an impact on the quality of life of patients.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"15-21"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996999","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":"Tuberous Breast and Poland Syndrome: An Underestimated Association?","authors":"Valentina Forlini, Simonetta Franchelli, Maria Victoria Romanini","doi":"10.1055/a-2494-7611","DOIUrl":"10.1055/a-2494-7611","url":null,"abstract":"<p><strong>Aim of the study: </strong> Both Poland syndrome (PS) and tuberous breast (TB) are anomalies affecting the breast, but they are considered mutually exclusive. Our aim was to determine the possible coexistence of PS and TB and to discuss TB management when associated with PS.</p><p><strong>Methods: </strong> Between 2010 and 2023, 51 female adolescent PS patients were studied at our center. Among these, we evaluated those who developed TB after puberty. PS diagnosis was made based on the hypoplasia or absence of pectoralis major muscle detected clinically and confirmed radiologically. Breast anomaly on PS side was classified with Thorax Breast and Nipple (TBN) classification: B1 corresponds to breast hypoplasia, B2 to breast aplasia. TB diagnosis was made with a clinical evaluation after puberty. TB cases were classified according to Grolleau classification.</p><p><strong>Main results: </strong> Among 51 postpubertal PS females, we identified 23 (45%) who developed TB. In 3 cases (13%) TB was bilateral, in 20 (87%) contralateral to PS affected side. Age at time of the first surgical procedure was 16 years. Patients were treated with breast implants, fat grafting, rigotomy, local flaps, or a combination of these. TB treatment was performed simultaneously with PS breast reconstruction when feasible, or after it.</p><p><strong>Conclusions: </strong> TB incidence in our series was almost twice than in general population. This is the first study demonstrating and quantifying this association. TB deformity must be considered while defining PS surgical path in adolescents. Fat grafting is the first surgical option to treat both anomalies. A multidisciplinary approach is needed to minimize number of surgeries and maximize cosmetic results.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"9-14"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775163","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":"Editorial Overview: Highlights from the 25th EUPSA Congress, Bologna, 2024.","authors":"Annika Mutanen, Martin Lacher","doi":"10.1055/a-2494-3005","DOIUrl":"https://doi.org/10.1055/a-2494-3005","url":null,"abstract":"","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":"35 1","pages":"1"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043766","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":"Interferential Current Stimulation Enhances Rectal Motor Activity: Insights from an Isolated Perfused Porcine Model.","authors":"Richard Martel, Michael Boettcher, Michaela Klinke Petrowsky, Nicolas Andres Hoyos, Irmgard Herrmann, Walter Magerl, Martin Herrmann","doi":"10.1055/a-2482-5997","DOIUrl":"10.1055/a-2482-5997","url":null,"abstract":"<p><strong>Introduction: </strong> Interferential current (IFC) has been studied in several clinical trials for the treatment of bowel motility disorders, most often in children. However, only moderate effects are reported, and in contrast to IFC, the so-called placebo application is indiscernible. The mechanisms and neuroanatomic points of action remain elusive. Therefore, this therapy remains being questioned.</p><p><strong>Methods: </strong> To gain objective experimental data about IFC stimulation, we examined this method ex vivo in an isolated perfused porcine rectum including the mesorectum. To elucidate the role of plexus nerve fibers and enteric ganglia, we performed IFC stimulation also in the presence of tetrodotoxin (TTX) or hexamethonium (HXN). We applied the commonly used stimulation modes with a beat frequency sweeping between 5 and 25 Hz (IFC_d5-25) and 80 and 150 Hz (IFC_d80-150). We monitored intraluminal pressure and motility by online barometry and video recording, respectively. Motor activity, reflected by changes in the intraluminal pressure (cm H₂O·s^-1) and longitudinal movements (pixels·s^-1), was quantified over time as root mean squares (RMSs).</p><p><strong>Results: </strong> After IFC_d5-25, we observed a 30% increase in the rectal motility in the pressure changes which was sustained over 30 minutes post-stimulation (<i>p</i> < 0.02); only a minor effect was detected for IFC_d80-150. Both TTX and HTX abolished the stimulation. This suggests neuronal modulation.</p><p><strong>Conclusion: </strong> IFC_d5-25 stimulates rectal motor activity in the isolated perfused porcine rectum. Ganglia in the enteric nervous system are modulated to allow increased activity for at least 30 minutes. Therefore, the isolated porcine rectum is a suitable tool to study the effectiveness of various IFC settings in the rectum.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"60-70"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717956","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":"Beyond the Chest Wall: Examining the Relationship between Morphological Features and Psychosocial Distress in Pectus Excavatum Patients.","authors":"Nicky Janssen, Jean H T Daemen, Luca Drtg van Hulst, Aimée J P M Franssen, Nadine A Coorens, Karel W E Hulsewé, Yvonne L J Vissers, Erik R de Loos","doi":"10.1055/a-2507-8195","DOIUrl":"10.1055/a-2507-8195","url":null,"abstract":"<p><strong>Introduction: </strong> Pectus excavatum patients frequently experience psychosocial distress, yet the relationship with morphological features of the deformity remains unexplored. We hypothesize that certain morphological features analyzed by 3D optical surface imaging contribute more prominently to the distress experienced by pectus excavatum patients as they impact the visible severity of the deformity.</p><p><strong>Materials and methods: </strong> Consecutive pectus excavatum patients who received three-dimensional optical surface imaging between August 2019 and November 2022 were included. Logistic regression analysis assessed the association between morphological features and psychosocial distress in which the distress was scored as a binary variable, based on a self-reported assessment.</p><p><strong>Results: </strong> Among 215 patients, 55% reported psychosocial distress with multivariable analyses revealing greater depth and length of the deformity being significantly correlated with psychosocial distress. However, this prediction model demonstrated a moderate discriminative ability with an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI], 0.59-0.73) for pectus depth and 0.58 (95% CI, 0.51-0.66) for pectus length.</p><p><strong>Conclusions: </strong> The morphological features of length and depth of the deformity are correlated with psychosocial distress. Nonetheless, these individual features are weak predictors due to their moderate discriminative ability. This underscores that other patient-related factors, such as personality traits, neuropsychological conditions, and other psychosocial influences, are likely to play a role in the occurrence of psychosocial distress. Future studies should investigate these variables alongside the incorporation of standardized instruments for measuring psychosocial distress to better understand and address the distress in this population.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886441","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":"Feasibility and Challenges of Pyeloureteral Magnetic Anastomosis Device in Domestic Pigs: A Stepwise Approach with Extended Observation.","authors":"Rainer Kubiak, Zita Hornok, Domokos Csukas, Andrea Ferencz, Tamas Cserni","doi":"10.1055/a-2507-8135","DOIUrl":"https://doi.org/10.1055/a-2507-8135","url":null,"abstract":"<p><strong>Objective: </strong> The pyeloureteral anastomosis remains the most challenging part of pyeloplasty. A purpose-built anastomotic device could simplify this step and potentially improve outcomes. The concept of a pyeloureteral magnetic anastomosis device (PUMA) was proven in minipigs, but only in short term. Our aim was to test the PUMA in domestic pigs and achieve a prolonged follow-up period.</p><p><strong>Methods: </strong> Five female domestic pigs underwent laparoscopy and ligation of the left ureter. Four weeks later, laparoscopic implantation of the PUMA was planned. Removal of the device and a retrograde contrast study were scheduled after another 4 weeks. The experiment was terminated when the animals could no longer be properly cared for due to their weight.</p><p><strong>Results: </strong> Due to unexpected smaller ureteric diameters, a modified PUMA could only be successfully inserted in pig number 3 (49 kg). Four weeks later, the device was found to be dislocated, but the anastomosis remained patent. After modifying the study protocol, the PUMA was successfully implanted in pigs number 4 (96 kg) and 5 (68 kg) 8 weeks after ureteric ligation. Pig 4 developed malignant hyperthermia and died. In pig 5, the magnets were removed 4 weeks later. After an additional 8 weeks, the animal reached 135 kg and was terminated. The anastomosis remained patent and preserved its diameter.</p><p><strong>Conclusion: </strong> Despite limitations, our study successfully demonstrated that the PUMA can achieve a patent ureteric anastomosis in domestic pigs. This suggests a potential for minimally invasive ureteric anastomosis in clinical settings. Further research is needed to optimize the technique and validate its effectiveness in humans.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017172","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":"Application of Jejunal Turnover and Bowel Plication Technique in Neonatal High Intestinal Atresia: A Retrospective Study.","authors":"Yu Zhao, Zhibo Zhang, Pengjun Su","doi":"10.1055/a-2155-7781","DOIUrl":"10.1055/a-2155-7781","url":null,"abstract":"<p><strong>Objective: </strong> To evaluate the outcomes of jejunal turnover and bowel plication (JTBP) in high jejunal atresia of neonates.</p><p><strong>Materials and methods: </strong> The clinical data of neonates that met the criteria were retrospectively analyzed from January 2012 to December 2021. The neonates were divided into the JTBP group and control group according to the surgical procedure. Demographics, postoperative morphology of the duodenum and proximal jejunum, intestinal recovery time, and complications were compared.</p><p><strong>Results: </strong> A total of 75 patients were allocated to the JTBP (<i>n</i> = 30) and control (<i>n</i> = 45) groups, respectively. There was no significant difference between the two groups in terms of gestational age, birth weight, age at surgery, the pathological classification, and concomitant disease. Upper gastrointestinal contrast study showed that the diameter of the proximal bowel of the anastomotic stoma was normal and the duodenum and proximal jejunum were in streamline shape in the JTBP group. While the duodenum was dilated, the shape of Trojan angle was classified into sharp angle and blunt round angle in the control group. The duration of total parenteral nutrition, postoperative oral feeding time, and oral feeding time of 40 mL/3 h were significantly different between the JTBP group and control group (sharp and blunt round type): 9.0 ± 3.5, 7.0 ± 2.1, and 11.0 ± 6.0 versus 16.9 ± 4.2, 14.0 ± 5.0, and 19.0 ± 7.4 versus 11.9 ± 8.3, 8.2 ± 3.9, and 15.8 ± 3.6 days (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong> JTBP for neonatal high jejunal atresia can significantly change the diameter of the proximal bowel and the course of duodenum jejunum flexure. Postoperative bowel movement was more in line with fluid dynamics, which was conducive to the recovery of the intestinal function and resulted in fewer complications.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10374668","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":"Intercostal Nerve Cryoablation as an Effective Pain Management Strategy in the Nuss Procedure: Reducing Opioid Use and Hospital Stay.","authors":"Lisgelia Santana, Mario Abels, John Driggers, Norman Carvalho","doi":"10.1055/a-2490-1091","DOIUrl":"https://doi.org/10.1055/a-2490-1091","url":null,"abstract":"<p><strong>Introduction: </strong> Erector spinae plane (ESP) blocks, thoracic epidural, and patient-controlled analgesia (PCA) have all been used for perioperative pain management in the Nuss procedure without a consensus on what modality produces the best outcomes. Intercostal nerve cryoablation (INC) is a relatively new modality that involves freezing the nerves to prevent pain during recovery. Our hypothesis is that using INC for the Nuss procedure will decrease opioid use, pain scores, and length of stay (LOS) but will increase cost compared with ESP block, thoracic epidural, and PCA.</p><p><strong>Materials and methods: </strong> This retrospective, observational study compared 108 patients who underwent the Nuss procedure at a pediatric acute care children's hospital in the southeast US. Patient charts were evaluated for significant differences in LOS, opioid use, and reported pain ratings based on type of analgesia administered: INC (<i>n</i> = 30), ESP block (<i>n</i> = 19), thoracic epidural (<i>n</i> = 41), and PCA (<i>n</i> = 18). Secondary variables included emergency department visits, readmissions, opioid refills, and various anesthetic and operative costs. Analysis of variance was performed on all outcome measures.</p><p><strong>Results: </strong> Average LOS was significantly decreased in the INC group (2.9 days) compared with the thoracic epidural (4.7 days, <i>p</i> < 0.05) and the PCA groups (3.7 days, <i>p</i> < 0.05). Average cumulative opioid use was significantly decreased in the INC group (50.4 morphine milligram equivalents [MME]) compared with the thoracic epidural (117 MME, <i>p</i> < 0.05) and PCA groups (172.1 MME, <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong> This study suggests that INC can be a viable and cost-effective option for reducing postoperative opioid consumption and LOS in Nuss procedure patients. Pain perception was lower in the INC group compared with the rest of the groups, except the epidurals, which were similar. However, the opioid consumption of the INC group was significantly lower than any other group. Despite the INC group having higher initial costs, it did not result in the highest total hospital charges, indicating its potential cost-effectiveness. There is a need for larger prospective randomized controlled trials to guide future research efforts.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866561","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}