Annali Italiani Di Chirurgia[JOURNAL]
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200 papers
Predicting the Severity of Postoperative Symptoms Following Mandibular Third Molar Extractions Using Machine Learning Techniques.
Hou Q, Ge H, Xiang J … +1 more , Gao Y
Ann Ital Chir · 2026 Jan · PMID 41537199 · Publisher ↗
AIM: This study aims to develop and externally validate machine-learning models that effectively predict the risk and severity of postoperative symptoms one week following mandibular third molar extractions. METHODS: Thi...
AIM: This study aims to develop and externally validate machine-learning models that effectively predict the risk and severity of postoperative symptoms one week following mandibular third molar extractions. METHODS: This retrospective cohort study included 321 patients (18-35 years old) who underwent lower third-molar surgery. Demographics, Pell-Gregory vertical (PGV) and Pell-Gregory level (PGL) classifications, surgical variables, and day-7 pain visual analogue scale (VAS) were recorded for all participants. The data were randomly divided into training (70%) and validation (30%) datasets. Five machine-learning algorithms-Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), and Neural Network (NNET)-were developed using nested cross-validation. Model performance was assessed through area under the receiver operating characteristic (AUROC) values, Brier scores, and calibration slopes, with a nomogram constructed from the best-performing model. RESULTS: GBM achieved the highest discrimination on the validation dataset with an AUROC of 0.687 (95% CI, 0.624-0.744), followed by the Neural Network (AUROC = 0.677). The GBM model yielded a calibration slope of 0.98 and a Brier score of 0.225, indicating excellent predictive accuracy. However, the top six predictors were found to be operative time, mouth opening, PGV, PGL, smoking, and preoperative symptoms. The GBM model, which underlies the nomogram, achieved an area under the curve (AUC) value of 0.666, indicating its discrimination capability. Additionally, the calibration curve confirmed the model's accuracy, and the decision curve analysis (DCA) suggested that the nomogram provides clinically promising potential for effective risk stratification. CONCLUSIONS: A GBM-based nomogram provides moderate yet clinically useful discrimination for healthy adults aged 18-35 years at risk for severe early symptoms after third-molar extraction. However, this approach requires external validation in older or medically complex patients before it is recommended for clinical predictions.
The Impact of Anesthesia and Surgical Intervention on Liver and Kidney Function in Patients With Gynecological Malignancies.
Zhang J, Feng J, Yin C … +3 more , Dong Z, Xu G, Yao L
Ann Ital Chir · 2026 Jan · PMID 41537198 · Publisher ↗
AIM: Gynecological malignancies are common cancers in women, with postoperative liver and kidney function impairment significantly impacting long-term prognosis. Therefore, this study aimed to evaluate the effects of ane...
AIM: Gynecological malignancies are common cancers in women, with postoperative liver and kidney function impairment significantly impacting long-term prognosis. Therefore, this study aimed to evaluate the effects of anesthesia and surgical interventions on postoperative liver and kidney function in patients with gynecological malignancies and explore its association with long-term survival outcomes. METHODS: This single-center retrospective cohort study included 153 patients who underwent surgery for ovarian cancer (50 cases), endometrial cancer (63 cases), and cervical cancer (40 cases) at Peking University International Hospital between 2018 and 2023. Demographic data, anesthesia methods (general or regional), surgical approaches (laparoscopic or open), and perioperative hepatorenal function indicators (Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Total Bilirubin (TBIL), creatinine and urea) were analyzed. Multivariate regression analysis adjusted for potential confounders, and survival models assessed long-term patient outcomes. RESULTS: Analysis of variance (ANOVA) revealed significant differences among the three cohorts in postoperative levels of ALT ( = 0.044), AST ( < 0.001), TBIL ( < 0.001), creatinine ( = 0.026), and urea ( < 0.001). Within each cohort, significant postoperative elevations were observed for ALT, AST, TBIL, creatinine, and urea compared to preoperative levels (all < 0.05). Intergroup comparisons revealed that cervical cancer patients exhibited the most severe biochemical disturbances (95% stage IV, < 0.001), with significant postoperative decreases in red blood cell (RBC) count ( < 0.001), hemoglobin (Hb) levels ( < 0.001), and platelet count ( = 0.003), alongside a substantial increase in white blood cell (WBC) count ( < 0.001). Multivariate linear regression analysis revealed that advanced tumor stage (Stage IV vs. I) was independently associated with elevated postoperative ALT ( = 0.001), AST ( < 0.001), TBIL ( < 0.001), and urea ( = 0.002) levels; however, its association with creatinine levels did not reach statistical significance ( > 0.05). Further analysis demonstrated that open surgery (vs. laparoscopic) significantly predicted increased creatinine ( = 0.002) and urea ( = 0.015) levels and TBIL ( = 0.002), whereas no significant effects were observed on ALT or AST ( > 0.05). Moreover, prolonged operative time (per 10 minutes) independently contributed to elevated AST ( = 0.015), TBIL ( = 0.018), and urea levels ( < 0.001). Similarly, intraoperative blood loss (per 100 mL) was associated with higher AST ( = 0.002), TBIL ( = 0.003), and urea levels ( = 0.003), while its associations with ALT ( = 0.083) and creatinine ( = 0.089) were not significant. Notably, pathological grade (G3 vs. G1), mode of anesthesia (general vs. local anesthesia), and age were not significantly associated with these biomarkers ( > 0.05). Furthermore, survival analysis revealed significantly reduced 5-year survival in patients with hepatorenal dysfunction, with survival curves diverging markedly from 32 months post-surgery ( < 0.001). CONCLUSIONS: Perioperative hepatorenal injury in gynecological malignancies is independently associated with tumor stage, open surgery, prolonged operative time, intraoperative blood loss, and tumor biology, and it critically impacts long-term survival. Therefore, minimally invasive techniques and optimizing perioperative management are essential to reduce organ damage and improve patient outcomes.
Prognostic Value of Tumor Regression Systems and Lymph Node Regression in Gastric Adenocarcinoma After Neoadjuvant Chemotherapy.
Gündoğar Ö, Bektaş S, Karatay H … +7 more , Paşaoğlu E, Özcan TB, Yıldırım Erdoğan N, Akbaş P, Yıldırım E, Yüksel S, Özkul Ö
Ann Ital Chir · 2026 Jan · PMID 41537197 · Publisher ↗
AIM: This study aimed to assess the prognostic significance of various histologic tumor regression grade (TRG) systems (Becker, American Joint Committee on Cancer (AJCC)/College of American Pathologists (CAP), Japanese G...
AIM: This study aimed to assess the prognostic significance of various histologic tumor regression grade (TRG) systems (Becker, American Joint Committee on Cancer (AJCC)/College of American Pathologists (CAP), Japanese Gastric Cancer Association (JGCA), JGCA2017, China, Mandard) and lymph node (LN) regression in patients with locally advanced gastric adenocarcinoma who underwent gastrectomy following neoadjuvant chemotherapy (NACT). METHODS: A retrospective cohort of 134 patients with locally advanced gastric adenocarcinoma from January 2020 to March 2024 who received NACT followed by gastrectomy was analyzed. Due to incomplete records, only the fact that patients received NACT was used, without specific regimen details. Surgical specimens were evaluated by two pathologists according to Becker, AJCC/CAP, JGCA, JGCA2017, China, and Mandard TRG systems. LN regression was categorized as positive/negative and coded as three categories (Code 1: metastasis without regression; Code 2: metastasis with regression; Code 3: regression without metastasis). Clinicopathologic variables, overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier curves and log-rank tests. Univariable and multivariable Cox regression models included each TRG subgroup as dummy variables and relevant covariates. Statistical significance was defined as < 0.05. RESULTS: The median follow-up time was 24 months (range 6-60). The median OS was 18.7 months (95% CI 16.2-21.3), while the median DFS was 16.4 months (95% CI 14.1-18.7). In the univariable analysis, JGCA2017 Score 0 (hazard ratio [HR] 0.28; 95% CI 0.12-0.65; = 0.003), Score 1a (HR 0.36; 95% CI 0.16-0.83; = 0.017), and clinical N3 stage (HR 1.95; 95% CI 1.15-3.30; = 0.013) were significantly associated with both OS and DFS. In multivariable Cox models, independent predictors of OS were JGCA2017 Score 0 (HR 0.25; 95% CI 0.11-0.59; = 0.002), Score 1a (HR 0.33; 95% CI 0.15-0.76; = 0.009), cN3 (vs cN1-2; HR 2.05; 95% CI 1.18-3.56; = 0.010), and positive LN regression (HR 0.42; 95% CI 0.23-0.77; = 0.005). Regarding DFS, JGCA2017 Score 0 (HR 0.30; 95% CI 0.12-0.75; = 0.009), cN3 (vs cN1-2; HR 1.90; 95% CI 1.10-3.30; = 0.020), and positive LN regression (HR 0.50; 95% CI 0.28-0.90; = 0.018) were independent predictors. Other TRG systems' subgroups did not remain significant in multivariable models. Notably, the JGCA2017 Score 0/1a categories independently predicted better OS and DFS, whereas positive LN regression also emerged as a protective prognostic factor. CONCLUSIONS: JGCA2017 subgroups are the most robust prognostic indicators for OS and DFS in patients with gastric adenocarcinoma following NACT. Positive LN regression is also an independent protective factor. Prospective validation and international standardization of these grading systems are warranted.
An Eventful Sleeve Gastrectomy: A Case Report and Literature Review.
Sorysz Z, Walędziak M, Bednarek M … +2 more , Szpakowski S, Różańska-Walędziak A
Ann Ital Chir · 2025 Sep · PMID 41399226 · Publisher ↗
AIM: Sleeve gastrectomy is the most common bariatric procedure in Poland. The procedure leads to reduction of stomach volume by 85%, allowing the intake of food of approximately 100-150 mL. The complication rate is usual...
AIM: Sleeve gastrectomy is the most common bariatric procedure in Poland. The procedure leads to reduction of stomach volume by 85%, allowing the intake of food of approximately 100-150 mL. The complication rate is usually low as it is one of the least invasive bariatric procedures with a short recovery pathway. CASE PRESENTATION: A 34-year-old male with a history of bipolar disorder and Body Mass Index of 46 kg/m underwent a sleeve gastrectomy in a regional center. Due to anastomosis leakage diagnosed in the postoperative period, the patient was transferred to a referral bariatric center. The patient underwent revision laparotomy, during which a self-expandable metal stent was placed. After the revision surgery, the patient complained of stomach pain and left shoulder pain and gastroduodenal fistula was diagnosed. Vacuum wound therapy was initiated and a pigtail drain was implanted into the fistula canal. Despite multiple sessions of therapy, the patient developed recurrent thoracic empyema, ultimately requiring the creation of an esophago-ileal anastomosis. No further complications occurred, and the patient was discharged home in good condition. RESULTS: Following early postoperative anastomotic leakage, the patient developed a gastric fistula. The recurrent thoracic empyema persisted despite multiple surgical and endoscopic interventions, including vacuum wound therapy, drainage, and stenting. Further, the patient required surgery to create an esophago-ileal anastomosis. The case shows a rare but complex and severe complication due to patient's incompliance regarding the calorie intake, volume and temperature of the meals and alcohol consumption. CONCLUSIONS: In case of suspected postoperative complications after bariatric surgery, including bleeding or staple line leaks, referral to specialist bariatric center may be recommended. Patients should be strongly advised to follow the postoperative dietary recommendations to reduce the risk of complications.
Systematic Review of Length of Stay After Carotid Endarterectomy and Carotid Artery Stenting.
Lehmann S, Hoene A, Golbach R … +3 more , Epple J, Debus ES, Grundmann RT
Ann Ital Chir · 2025 Oct · PMID 41399225 · Publisher ↗
AIM: This systematic review with meta-analysis aims to compare postoperative length of stay (LOS) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) and to identify potentially modifiable risk factors f...
AIM: This systematic review with meta-analysis aims to compare postoperative length of stay (LOS) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) and to identify potentially modifiable risk factors for prolonged hospitalization. METHODS: This systematic review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A literature search was conducted in PubMed using the keywords "carotid endarterectomy" AND "length of stay", "carotid artery stenting" AND "length of stay", and "transcarotid arterial revascularization" AND "length of stay", over a 10-year period (September 2012-September 2023). RESULTS: The final analysis included 77 studies on CEA and 30 on CAS/transcarotid arterial revascularization (TCAR), with 15 studies reporting on both CEA and CAS. In total, 3,952,240 CEA patients (59.14% male, 40.86% female) and 201,937 CAS patients (62% male, 38% female) were included. Of the CEA patients, 77.93% were asymptomatic, compared to 63% of CAS patients (p = 0.671). The LOS was 2.04 days for CEA and 2.52 days for CAS (p = 0.399). In-hospital mortality was 0.3% for CEA and 0.57% for CAS (p = 0.132), while 30-day mortality was significantly higher for CAS (1.16% vs. 0.77%, p < 0.001). A higher percentage of symptomatic patients (estimate 0.0280; 95% CI: 0.0097-0.0462; p = 0.003), frail patients (estimate 0.0887; 95% CI: 0.0068-0.1706; p = 0.034) and major adverse cardiovascular events (MACE) patients (estimate = 0.3658; 95% CI: 0.1938-0.5379; p < 0.001) was associated with prolonged LOS after CEA. For higher proportions of CAS patients with chronic obstructive pulmonary disease (COPD) a longer LOS was observed (estimate 0.0960; 95% CI: 0.0029-0.1891; p = 0.043), while higher proportions of patients with arterial hypertension led to a shorter LOS (estimate -0.0545; 95% CI: -0.0884-(-0.0206); p = 0.002). A higher proportion of neurological complications was also associated with prolonged LOS in CAS (estimate 0.1622; 95% CI: 0.0805-0.2439; p < 0.001). Higher proportions of patients who received preoperative use of acetylsalicylic acid (Preop. ASA) led to a significantly shorter LOS for both CEA and CAS. CONCLUSIONS: CEA and CAS did not significantly differ in postoperative LOS or in-hospital mortality, but CAS had a higher 30-day mortality rate. Since postoperative complications, preoperative hypertension, and preoperative antiplatelet therapy are modifiable, LOS can serve as a quality parameter for CEA and CAS.
Surgical Techniques for the Treatment of Hirschsprung's Disease-A Historical Systematic Review and Current Status Quo.
Hager J, Sergi CM
Ann Ital Chir · 2025 Oct · PMID 41399224 · Publisher ↗
AIM: Hirschsprung's disease, or aganglionosis of the colon, is a congenital disease characterized by a lack of neurons in the enteric plexus of the large bowel due to either migration failure or defective differentiation...
AIM: Hirschsprung's disease, or aganglionosis of the colon, is a congenital disease characterized by a lack of neurons in the enteric plexus of the large bowel due to either migration failure or defective differentiation of neural crest cells. We aimed to conduct a historical systematic review of available literature and personal experience to exhibit the surgical techniques performed in the past and the current status quo of surgery for Hirschsprung's disease. METHODS: We searched PubMed, EMBASE, Google Scholar databases for studies examining surgery in aganglionosis or Hirschsprung's disease. The search included all studies published from inception until 9 November 2024. Eligible criteria included all peer-reviewed articles, not necessarily written in English, but also German, French, Italian, and Spanish items dealing with surgery and the prognosis of patients with Hirschsprung's disease after surgical intervention. RESULTS: A total of 2527 studies were reviewed, and the studies relevant to the surgery were extracted for this historical review. This article delivers a unique historical path and an analysis of some of the most critical surgical techniques for the approach to Hirschsprung's disease, with two outstanding sections on innovative robotic-assisted surgery and life quality after surgery. Currently, surgeons often tailor their approach to Hirschsprung's disease by combining their knowledge and expertise on several surgical procedures and incorporating subtle adjustments based on each patient's imaging, inspection, and pathological findings. The conventional wisdom held that surgeons should perform whichever surgery they felt most comfortable with, regardless of whether a particular technique produced better results. Although the core elements of surgical care have been identified and surgery has been shown to improve outcomes in patients affected with Hirschsprung's disease, the precise etiology and correct treatment for reconstitution of ganglion cells in the aganglionic portions of the bowel are lacking. The surgical treatment options for Hirschsprung's disease have been conceived and implemented after the etiology of Hirschsprung's disease was successfully clarified in the 1940s. CONCLUSIONS: There is still no internationally valid agreement on which techniques should be used for the various forms of intestinal aganglionosis, especially for total colonic and ultra-short intestinal forms. On the other hand, minimally invasive surgery, artificial intelligence, and machine learning are quickly entering medicine and surgery. These approaches will probably modify the surgical approaches to Hirschsprung's disease. In the future, surgeons may integrate new knowledge derived from proteomics and genomics into current surgical procedures. This integration pinpoints a therapeutic approach that may eventually entail aspects of personalized medicine.
Current Practices and Perspectives on Ambulatory Thyroid Surgery in Italy: A Survey by the Società Italiana Chirurgia Endoscopica e Nuove Tecnologie (SICE) in Preparation for the DECORATED Trial.
Carrano FM, Casaril A, Manella S … +8 more , Rapanotti E, D'Angelo F, Silecchia G, Anania G, Cuccurullo D, Pilone V, Currò G, SICE Decorated Study Group
Ann Ital Chir · 2025 Nov · PMID 41399223 · Publisher ↗
AIM: The Coronavirus disease 19 (COVID-19) pandemic has significantly impacted elective thyroid surgery, leading to a reduction in procedures and an increase in waiting lists. In response, thyroidectomy is increasingly b...
AIM: The Coronavirus disease 19 (COVID-19) pandemic has significantly impacted elective thyroid surgery, leading to a reduction in procedures and an increase in waiting lists. In response, thyroidectomy is increasingly being performed as an outpatient procedure worldwide, with comparable outcomes and readmission rates to those of overnight stays after surgery in high-volume centers. However, in Italy, ambulatory thyroid surgery is rarely practiced because of concerns about the safety and efficacy of such approaches. This specific timeframe represents a unique opportunity to capture a snapshot of the Italian thyroid surgery practices and drive a practice change while providing a practical solution to the huge backlog of procedures. METHODS: A survey was conducted among Italian surgical centers to assess their practices and preferences regarding various aspects of thyroid surgery, including preoperative assessment, intraoperative techniques, and postoperative care. The survey also explored the use of minimally invasive approaches and the adoption of day surgery or overnight stay procedures. Data were collected through a structured questionnaire. The survey data were analyzed using descriptive statistics and clustering techniques to identify patterns and groupings among surgeons on the basis of their responses. RESULTS: A variety of practices have emerged among surgeons performing thyroid surgery, with varying preferences for hemostatic methods, additional hemostasis techniques, and the use of drains. A significant proportion of surgeons (47%) still favor traditional inpatient stays for thyroid surgery, whereas others offer day surgery or overnight stays for selected cases (53%). The use of intraoperative nerve monitoring is widespread (73%), but the choice of monitoring methods and the factors influencing its use vary among surgeons. Only 21% of surgeons rely solely on traditional suture ligations for hemostasis, whereas 41% routinely use hemostatic absorbable gauze for additional hemostasis. Minimally invasive approaches, such as Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) (23%) and robotic surgery (7%), are also utilized. Day surgery is offered only in academic hospitals and endocrine surgery referral centers. CONCLUSIONS: Significant variation exists in thyroid surgery practices, emphasizing the need for further research and standardized protocols, particularly in areas such as preoperative assessment, hemostasis techniques, and postoperative care. By establishing best practices, surgeons can confidently expand the offering of day-surgery and one-day surgery options, leading to shorter waiting lists and improved patient care. This shift toward more efficient and patient-centered approaches requires collaborative efforts among surgeons and hospitals to ensure safety and optimal outcomes for patients undergoing thyroid surgery.
Construction and Validation of a Risk Prediction Model for Peristomal Moisture-Associated Skin Damage in Older Patients With Enterostomies.
Chen L, Liang L, Chen Y … +1 more , Chen J
Ann Ital Chir · 2025 Dec · PMID 41399222 · Publisher ↗
AIM: This study aimed to identify the risk factors for peristomal moisture-associated skin damage (PMASD) in older patients with enterostomies and to develop a predictive model. METHODS: This is a retrospective study. Da...
AIM: This study aimed to identify the risk factors for peristomal moisture-associated skin damage (PMASD) in older patients with enterostomies and to develop a predictive model. METHODS: This is a retrospective study. Data were collected from older patients who underwent enterostomy at The Fifth Affiliated Hospital of Wenzhou Medical University in Lishui between January 2021 and December 2022. With peristomal moisture-associated skin damage as the outcome variable, predictors identified as significant in the univariate analysis were incorporated into a multivariate logistic regression model. The model's goodness-of-fit and discriminative ability were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve (AUC). To further evaluate the model's stability and predictive performance, an internal validation was conducted using a time-stratified cohort of 68 patients consecutively recruited from the same hospital between January 2023 and December 2023. RESULTS: The incidence of PMASD was 42.59% in the model development group (n = 162) and 41.18% in the validation group (n = 68). Independent predictors of PMASD included surgical incision in the stoma baseplate area (odds ratio [OR] = 4.80; 95% confidence interval [CI], 1.04-7.51), ileostomy (OR = 3.49; 95% CI, 1.27-7.99), history of radiotherapy (OR = 1.49; 95% CI, 1.05-2.10), lack of preoperative stoma marking (OR = 5.07; 95% CI, 2.50-8.30), and peristomal skin folds (OR = 3.96; 95% CI, 2.53-16.10), while stoma height ≥1.3 cm (OR = 0.11; 95% CI, 0.04-0.29) and continuity of care (OR = 0.60; 95% CI, 0.45-0.80) were protective factors. The model showed good discrimination (area under the receiver operating characteristic curve [AUC] = 0.90; 95% CI, 0.86-0.95) and calibration (Hosmer-Lemeshow p = 0.851) in the model development group and maintained strong performance in the validation group (AUC = 0.91; Hosmer-Lemeshow p = 0.875). CONCLUSIONS: The validated prediction model demonstrated high discrimination (AUC >0.90) and good calibration, providing an effective tool for the early identification of older patients undergoing enterostomy at high risk of PMASD. This model may guide individualized preventive strategies and optimize the continuity of care. Further multicenter prospective studies are needed to confirm the generalizability and clinical utility of our findings.
Using Implantable Artificial Dermis-PELNAC as a Functional Material to Guide Reconstruction of Finger Body Defect.
Yang H, Zhou W, Dong Y … +12 more , Zhou H, Alhaskawi A, Shen W, Hasan Abdullah Ezzi S, Goutham Kota V, Hasan Abdulla Hasan Abdulla M, Chen S, Wen F, Sun Z, Alenikova O, Ahmed Abdalbary S, Lu H
Ann Ital Chir · 2025 Dec · PMID 41399221 · Publisher ↗
AIM: Managing partial defects of the finger is crucial for both function and aesthetics, especially when bone or tendon is exposed. Permacol Enhanced Layer for Neodermis and Coverage (PELNAC), an artificial dermis, serve...
AIM: Managing partial defects of the finger is crucial for both function and aesthetics, especially when bone or tendon is exposed. Permacol Enhanced Layer for Neodermis and Coverage (PELNAC), an artificial dermis, serves as a promising scaffold in surgical procedures, providing wound protection and promoting tissue healing. This study assesses the effectiveness of PELNAC in treating a range of partial finger defects. METHODS: We assessed PELNAC's morphology and microstructure using scanning electron microscopy, characterized its degradation profile over six weeks in simulated body fluid, and confirmed its cytocompatibility with L929 cell cultures. In the clinical setting, 47 patients with 56 partial finger defects (both superficial and deep) were treated using PELNAC alone. Outcome measures included wound closure time, range of motion (ROM), sensory recovery (two-point discrimination), Vancouver Scar Scale (VSS) scores, and patient satisfaction. RESULTS: Scanning electron microscopy revealed interconnected micropores in PELNAC, with a porosity of 81.3 ± 2.1% and aperture sizes of 40-70 µm (top view) and 60-100 µm (section view). After six weeks in simulated body fluid, PELNAC retained 86.4 ± 1.5% of its weight, and cells proliferated well on its surface. All treated wounds healed without the need for split-thickness skin grafts, with an average closure time of 58.7 ± 12.8 days (range: 30-84 days). Age showed weak positive correlation with healing time (r = 0.152, p < 0.01) and weak negative correlation with two-point discrimination (r = -0.55, p < 0.01). Longer healing times correlated with reduced ROM (r = -0.143, p < 0.01), while higher VSS scores were linked to poorer functional outcomes (r = -0.22, p < 0.01). The average ROM in patients with distal interphalangeal joint (DIPJ) defects was 49° (IQR: 45-56.25°). Sensory recovery averaged 5.95 mm (IQR: 5.175-6.7 mm). The mean VSS score was 2 (IQR: 1-3), indicating minimal scarring. Patient satisfaction was high (functional score: 9 (IQR: 8-9.25)), with no severe complications reported. CONCLUSIONS: This study evaluates the clinical and biomechanical effectiveness of PELNAC as a single-stage reconstructive material for partial finger defects. PELNAC facilitates wound healing without secondary skin grafts, preserving joint mobility, promoting sensory recovery, and minimizing scarring. The results highlight PELNAC as a simple, safe, and effective alternative to traditional approaches, reducing donor site morbidity and eliminating the need for multiple surgeries.
Hiatal Hernia Recurrence After Laparoscopic Repair: Is Always a True Recurrence?
Fabbi M, Galli F, Liepa L … +8 more , Bardelli L, Milani MS, Frattini F, Iovino D, Pappalardo V, Pavesi F, Rocchi PA, Rausei S
Ann Ital Chir · 2025 Dec · PMID 41399220 · Publisher ↗
Abstract loading — click title to view on PubMed.
Colorectal Malignant Polyps: Characterization and Endoscopic Resection Technique.
Tomasello G, Basset CA, Chiodo R … +8 more , Bartolomeo D, Carini F, Sartor MC, Dosh L, Ei-Masri J, Jurjus A, Leone A, D'Andrea V
Ann Ital Chir · 2025 Dec · PMID 41399219 · Publisher ↗
Colorectal cancer, currently the third most common malignancy worldwide, can be significantly reduced through early detection and endoscopic resection of polyps. This review discusses the main classifications of colonic...
Colorectal cancer, currently the third most common malignancy worldwide, can be significantly reduced through early detection and endoscopic resection of polyps. This review discusses the main classifications of colonic lesions and the most effective evidence-based technologies for their detection, characterization, and management. A practical roadmap for risk stratification and a management algorithm are proposed, based on the latest recommendations from the European and American Societies of Gastrointestinal Endoscopy. By combining clinical experience with a critical analysis of key studies from the past decade, this article provides practical tools to enhance optical diagnosis and guide therapeutic decisions, minimizing the need for surgical interventions. This review serves as an essential resource for clinicians, offering practical guidance for effective and individualized management of colorectal lesions, thereby enhancing cancer prevention and optimizing healthcare resource utilization.
Impact of Intraoperative Ultrasound-Guided Loop Electrosurgical Excision Procedure With Individualized Marking on Perioperative Stress Responses, Immune Parameters, and Clinical Outcomes: A Comparative Study With Conventional Surgery.
Bai Y, Wu S, Zhang L
Ann Ital Chir · 2025 Dec · PMID 41399218 · Publisher ↗
AIM: This study compared the standard loop electrosurgical excision procedure (LEEP) with an enhanced technique incorporating intraoperative ultrasound guidance and individualized marking for high-risk human papillomavir...
AIM: This study compared the standard loop electrosurgical excision procedure (LEEP) with an enhanced technique incorporating intraoperative ultrasound guidance and individualized marking for high-risk human papillomavirus (HPV)-associated cervical lesions. The primary focus was on their differential impact on stress injuries incurred during the perioperative period. Furthermore, secondary outcomes included surgical precision, modulation of local immune microenvironment, and clinical endpoints, such as complications, HPV clearance, and recurrence. METHODS: This retrospective cohort study included high-risk HPV-induced cervical intraepithelial neoplasia (CIN) II-III patients (n = 122) who were treated between January 2022 and March 2024. Patients were divided into two groups: an observation group (n = 58), which received intraoperative ultrasound-guided LEEP with individualized marking, and a control group (n = 64), which received conventional LEEP. The outcome measures evaluated were (1) perioperative stress hormones and inflammatory markers, (2) surgical parameters (intraoperative blood loss, margin positivity, and cervical canal adhesion rates), (3) postoperative complications (infection, bleeding, and cervical canal stenosis), and (4) HPV clearance and recurrence rates. RESULTS: Postoperative stress and the levels of inflammatory markers were significantly reduced in the observation group compared to the conventional group (p < 0.05). However, the observation group demonstrated significant improvement, including reduced intraoperative bleeding, fewer positive margins, and increased HPV clearance rates (p < 0.05). Regarding postoperative complications, the observation group exhibited a significant reduction in acute infection and Cervical canal adhesion rates compared with the control group (p < 0.05). Finally, postoperative Visual Analogue Scale (VAS) and Hospital Anxiety and Depression Scale-anxiety (HADS-A) scores were lower in the observation group than in the control group (p < 0.05). CONCLUSIONS: The use of intraoperative ultrasound-guided LEEP with individualized marking is associated with attenuated perioperative stress responses and a more preserved immune microenvironment. This, in turn, improves HPV clearance rates and diminishes postoperative complication risks.
Combined Axillary-Femoral Artery Cannulation Versus Conventional Femoral Artery Single Cannulation: Cerebral Protection Benefits in Stanford Type A Aortic Dissection Repair Surgery.
Zhang H, Wang Z, Zhu Y … +2 more , Zhang Y, Wang Y
Ann Ital Chir · 2025 Dec · PMID 41399217 · Publisher ↗
AIM: Conventional femoral artery cannulation with retrograde perfusion may increase the incidence of cerebral embolism in treating Stanford type A aortic dissection (STAAD). This study aimed to compare the neuroprotectiv...
AIM: Conventional femoral artery cannulation with retrograde perfusion may increase the incidence of cerebral embolism in treating Stanford type A aortic dissection (STAAD). This study aimed to compare the neuroprotective effect of combined axillary-femoral artery cannulation utilizing an antegrade-retrograde perfusion strategy with femoral artery single cannulation in STAAD surgery. METHODS: This was a two-center, retrospective cohort study including 120 patients who underwent STAAD surgery between January 2021 and January 2025. Among them, 63 patients received combined axillary-femoral artery cannulation (double arterial cannulation group, DAC group), while 57 patients underwent conventional femoral artery single cannulation (single arterial cannulation group, SAC group). Perioperative parameters, neurological outcomes, including incidences of permanent/transient neurological dysfunction (PND/TND), delirium and coma duration, modified Rankin Scale (mRS) score, and Montreal Cognitive Assessment (MoCA) score, were evaluated. Serum biomarkers of brain injury, including neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) protein levels, as well as postoperative general complications, were also analyzed. RESULTS: There was no significant difference in the key perioperative time parameters between the two groups (p > 0.05). Regarding neuroprotection, the DAC group exhibited superior outcomes, with significantly lower incidences of PND and TND, and shorter coma and delirium durations (p < 0.05). The DAC group also achieved better mRS and MoCA scores at 30 and 90 days postoperatively (p < 0.001). Peak postoperative levels of NSE and S100B were significantly lower in the DAC group (p < 0.001). Multivariate linear regression analyses revealed that the DAC strategy was an independent protective factor associated with improved neurological function (mRS), enhanced cognitive performance (MoCA), lower brain injury biomarker levels (NSE and S100B), and reduced coma and delirium durations (p < 0.001). There was no significant difference in the overall incidence of postoperative general complications between the two groups (p > 0.05). However, the incidence of postoperative limb ischemia was significantly lower in the DAC group (p < 0.05). CONCLUSIONS: Compared with conventional femoral artery single cannulation, combined axillary-femoral artery cannulation provides superior and independent cerebral protection during STAAD surgery. This approach reduces permanent and transient neurological deficits, mitigates early brain injury, enhances neurological and cognitive recovery, and lowers the incidence of postoperative limb ischemia. It holds promise as a safe and effective cerebral protective perfusion strategy in STAAD surgical management.
Neuromuscular Electrical Stimulation Combined With Rehabilitation Training Improves Rehabilitation After Spinal Cord Injury.
He F, Zhang R, Sha F … +3 more , Hu Y, Zhang Z, Zheng M
Ann Ital Chir · 2025 Dec · PMID 41399216 · Publisher ↗
AIM: Spinal cord injury (SCI), particularly traumatic spinal cord injury (TSCI), is a globally prevalent neurological condition and often causes severe functional and physical disabilities. Neuromuscular electrical stimu...
AIM: Spinal cord injury (SCI), particularly traumatic spinal cord injury (TSCI), is a globally prevalent neurological condition and often causes severe functional and physical disabilities. Neuromuscular electrical stimulation (NMES), when combined with rehabilitation training, has been reported to enhance functional recovery in patients with SCI. However, its specific clinical advantages and safety profile require further validation through robust empirical data. Therefore, this study aims to investigate the synergistic effects of NMES combined with rehabilitation training on improving motor function and reducing muscle atrophy in SCI patients. METHODS: This retrospective study enrolled 856 patients with TSCI. All patients received either surgical intervention or conservative treatment based on injury severity. Among them, 472 patients received NMES combined with rehabilitation training (intervention group), while the remaining 384 patients received rehabilitation training alone (control group). Several parameters, including neurological function score, muscle mass, and quality of life (QoL) were compared pre- and post-interventions to evaluate the rehabilitation outcomes of the two groups. RESULTS: After treatment, the patients in the intervention group showed higher motor and sensory function scores (American Spinal Injury Association [ASIA] motor and ASIA sensory scores), walking speed on the 10-Meter Walk Test (10MWT), and muscle cross-sectional area (CSA) value than those in the control group (p < 0.05). However, no significant differences were observed between the two groups in Spinal Cord Independence Measure III (SCIM-III) scores, muscle quality index (MQI), and World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) scores (p > 0.05). CONCLUSIONS: Combining NMES with rehabilitation training can enhance motor function recovery, attenuate muscle atrophy, and improve walking ability in individuals with SCI. NMES-augmented rehabilitation offers superior benefits compared to rehabilitation alone.
Novel Gas-Liquid Drainage Tube for Electrosurgery: Safeguarding Health by Evacuating Toxic Gases and Improving Surgical Field Clarity.
Hu K, Wang L, Lu X … +1 more , Zhao K
Ann Ital Chir · 2025 Dec · PMID 41399215 · Publisher ↗
AIM: Surgical smoke generated during electrosurgery contains various toxic substances, including carbon monoxide (CO), hydrogen sulfide (HS), formaldehyde (HCHO), total volatile organic compounds (TVOC), and particulate...
AIM: Surgical smoke generated during electrosurgery contains various toxic substances, including carbon monoxide (CO), hydrogen sulfide (HS), formaldehyde (HCHO), total volatile organic compounds (TVOC), and particulate matter 2.5 (PM2.5), which pose a significant health threat to both surgical staff and patients. This study investigates the effectiveness of a novel gas-liquid drainage tube in removing surgical smoke and improving the safety of the surgical environment. METHODS: A gas detector and an air quality monitor were used to measure the concentrations of CO, carbon dioxide (CO), PM2.5, HCHO, TVOC, and HS in the rat model during electrosurgery. Animals were divided into two groups (n = 3 each): an experimental group employing a novel gas-liquid drainage tube and a control group using a traditional drainage tube. Measurements were taken at various time points (1, 5, 10, 15, 30, 60, and 120 min) and fixed distances from the surgical site (0, 10, 30, 50, 100, and 150 cm). Additionally, the effectiveness of the drainage tube in maintaining surgical field clarity during the procedure was evaluated using an image subtraction algorithm. RESULTS: Compared to the control group, the novel gas-liquid drainage tube significantly reduced the concentrations of CO, CO, PM2.5, HCHO, TVOC, and HS in the experimental group (p < 0.05). Furthermore, the drainage tube effectively reduced hazards and cleared smoke, thus improving the clarity of the surgical field. CONCLUSIONS: This device effectively reduces the concentration of harmful gases and particulate matter generated during electrosurgical procedures. These findings suggest that it may contribute to creating a cleaner, safer surgical environment.
On-Pump Versus Off-Pump Coronary Artery Bypass Grafting: A Comparison of Outcomes in Patients Receiving LIMA-LAD and Sequential No-Touch Saphenous Vein Graft Anastomoses.
Zhang X, Zheng Z, Chang Q … +3 more , Zhang Y, Huang C, Xu J
Ann Ital Chir · 2025 Dec · PMID 41399214 · Publisher ↗
AIM: Coronary artery bypass grafting (CABG), whether conducted using on-pump or off-pump strategies, exhibits distinct perioperative risk profiles. When combined with left internal mammary artery (LIMA) to left anterior...
AIM: Coronary artery bypass grafting (CABG), whether conducted using on-pump or off-pump strategies, exhibits distinct perioperative risk profiles. When combined with left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafting and sequential no-touch saphenous vein graft (SVG) anastomosis, these differences gain clinical relevance. Therefore, this study aims to compare the clinical outcomes of on-pump CABG and off-pump CABG in patients who uniformly received the LIMA-LAD graft combined with sequential no-touch SVG anastomosis. METHODS: This retrospective cohort study included 240 patients who received LIMA-LAD grafting combined with sequential no-touch SVG anastomosis between June 2019 and December 2023. Of the total patients, 61 received the procedure under cardiopulmonary bypass and were assigned to the on-pump group, while 179 underwent off-pump coronary artery bypass, categorized as the off-pump group. After propensity score matching (PSM; 1:1 ratio), 57 pairs were successfully matched and analyzed. The primary endpoint of the study included the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause mortality, myocardial infarction, stroke, or target vessel revascularization, within one year after surgery. A key secondary endpoint was a graft patency rate assessed within one year after the procedure, including the LIMA-LAD graft and the sequential SVGs. Other secondary endpoints included: (1) postoperative recovery metrics, such as intensive care unit (ICU) stay duration, duration of mechanical ventilation, volume of thoracic drainage, and blood transfusion requirements; (2) hemodynamic parameters at 24 hours post-operation, including cardiac index (CI), pulmonary artery wedge pressure (PAWP), left ventricular stroke work index (LVSWI), stroke volume index (SVI), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI); and (3) short-term postoperative complications (e.g., atrial fibrillation, acute kidney injury (AKI), sternal wound infection, and lower extremity venous territory infection). RESULTS: There was no significant difference in the one-year incidence of MACCE between the off-pump and on-pump groups (p > 0.05). Similarly, no significant differences were found in the one-year patency rates of the LIMA-LAD graft or the sequential SVGs between the two groups (p > 0.05). Compared to the on-pump group, the off-pump group had shorter ICU stays, reduced duration of mechanical ventilation, lower thoracic drainage volumes, and decreased blood transfusion requirements (p < 0.001). Furthermore, no significant difference was observed in total hospitalization duration between the two groups (p > 0.05). Preoperatively, none of the hemodynamic parameters achieved statistical significance between the two groups (p > 0.05). At 24 hours postoperatively, both groups showed substantial within-group improvements (off-pump: all parameters; on-pump: CI, PAWP, LVSWI, SVRI; p < 0.05). However, between-group comparisons revealed better CI, PAWP, LVSWI, SVI and SVRI levels in the off-pump group (p < 0.05). Within 1 month postoperatively, the off-pump group experienced a lower incidence of atrial fibrillation (p < 0.05). Additionally, there were no significant differences in the rates of AKI, sternal wound infection, or leg wound infection between the two groups within 2 months postoperatively (p > 0.05). CONCLUSIONS: Compared to on-pump CABG, off-pump CABG utilizing sequential no-touch SVG anastomosis offers advantages in terms of earlier recovery and superior hemodynamic performance without compromising graft patency or increasing the long-term risk of major adverse cardiovascular and cerebrovascular events.
Comparison of Efficacy Between the Bilateral Triceps-Sparing and Olecranon Osteotomy Approaches With Double-Plate Internal Fixation for AO Type C3 Distal Humeral Fractures.
Lan Y, Yang G, Sun D
Ann Ital Chir · 2025 Dec · PMID 41399213 · Publisher ↗
AIM: This study aims to compare the efficacy of the bilateral triceps approach (BTA) versus the olecranon osteotomy approach (OOA) with orthogonal double plating in managing Arbeitsgemeinschaft für Osteosynthesefragen (A...
AIM: This study aims to compare the efficacy of the bilateral triceps approach (BTA) versus the olecranon osteotomy approach (OOA) with orthogonal double plating in managing Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation type C3 distal humeral fractures, providing evidence for selecting optimal surgical approaches and fixation methods. METHODS: This retrospective analysis included 31 patients with AO type C3 distal humeral fractures treated at the Department of Orthopaedic Trauma, Orthopaedic Center, the First Hospital of Jilin University between June 2018 and May 2024. All patients underwent open reduction and internal fixation with orthogonal double plates placed dorsally on the radial column and medially on the ulnar column. Based on surgical approach, patients were divided into the BTA group (n = 16) and OOA group (n = 15). The parameters evaluated during this study included injury-to-surgery interval, operative time, intraoperative blood loss, postoperative complications (iatrogenic nerve injury, wound infection, elbow stiffness), and Mayo Elbow Performance Score (MEPS) at 6 and 12 months postoperatively. RESULTS: All patients achieved bony union and their fractures healed with complete follow-up. No statistically significant differences were observed in gender, age, or injury-to-surgery interval between groups (p > 0.05). Operative time was significantly shorter in the BTA group compared to the OOA group (p < 0.05). Similarly, there were no significant differences between the groups regarding intraoperative blood loss, postoperative complication rates, or excellent/good rates of MEPS at 6 or 12 months (all p > 0.05). CONCLUSIONS: For AO type C3 distal humeral fractures without metaphyseal defects, orthogonal double plating provides rigid fixation enabling early postoperative mobilization. For fractures with intact trochlear articular surfaces (no coronal/horizontal split) where fragments can be directly fixed by distal screws from the plates, the bilateral triceps approach may be prioritized. For severely comminuted trochlear fractures with articular fragmentation (coronal/horizontal split) requiring separate fixation of split fragments with headless compression screws, the olecranon osteotomy approach may provide better exposure.
Clinical Outcomes of 3D Laparoscopic Hiatal Hernia Repair Either Combined With Toupet Fundoplication or Nissen Fundoplication: A Comparative Analysis.
Zhu T, Gong D
Ann Ital Chir · 2025 Dec · PMID 41399212 · Publisher ↗
AIM: This study aimed to perform a rigorous comparison of perioperative and functional outcomes between the 3D laparoscopic Toupet (270° posterior partial fundoplication) vs. Nissen (360° total fundoplication) for hiatal...
AIM: This study aimed to perform a rigorous comparison of perioperative and functional outcomes between the 3D laparoscopic Toupet (270° posterior partial fundoplication) vs. Nissen (360° total fundoplication) for hiatal hernia (HH) repair in gastroesophageal reflux disease (GERD) patients. METHODS: This retrospective cohort study included 103 patients with HH and GERD who underwent surgery between January 2020 and May 2024. Patients were divided into two groups based on surgical technique: the Toupet group (n = 53) and the Nissen group (n = 50). Outcomes included surgical metrics, pre/postoperative high-resolution manometry, 24-hour pH-impedance, gastroesophageal reflux disease symptom questionnaire (GERD-Q) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and complications. Multivariable regression adjusted for baseline differences. RESULTS: The Toupet group demonstrated significantly shorter time to first postoperative oral intake (p = 0.012) and hospital stays (p = 0.023) compared to the Nissen group. At 6 months postoperatively, both groups showed significant increases in minimum lower esophageal sphincter (LES) resting pressure and respiratory mean values, along with decreases in reflux-related parameters and ineffective swallowing ratio (p < 0.001). Intergroup comparison revealed that the Toupet group had lower minimum LES resting pressure, respiratory mean LES pressure, and ineffective swallowing ratio, but higher 24-hour reflux episodes, percentage acid exposure time, and mean DeMeester scores than the Nissen group (p < 0.001). At 1 year postoperatively, both groups exhibited significant improvements in GERD-Q and GERD-HRQL scores (p < 0.001), with no intergroup differences observed (p > 0.05). The Toupet group had significantly lower overall complication rates (p = 0.031) and a lower incidence of dysphagia than the Nissen group (p = 0.019). Multivariable regression analyses confirmed that the Toupet procedure was an independent predictor for shorter time to first postoperative oral intake (p = 0.015), shorter hospital stays (p = 0.017), and lower overall complication rates (p = 0.020). CONCLUSIONS: In summary, when performed with 3D laparoscopy, Toupet and Nissen fundoplication show distinct and meaningful clinical profiles. Nissen fundoplication is the preferred option for achieving maximal anti-reflux efficacy in patients with normal esophageal motility, whereas Toupet fundoplication is preferred for minimizing postoperative dysphagia and enhancing rapid recovery, particularly in cases with impaired or borderline motility.
Comparative Assessment of Ultra-Minimally Invasive Approach versus Thoracoscopic Internal Fixation for Multiple Rib Fractures and Associated Thoracic Trauma.
Xu G, Zhang H
Ann Ital Chir · 2025 Dec · PMID 41399211 · Publisher ↗
AIM: This study aims to comparatively evaluate the ultra-minimally invasive rib fixation versus thoracoscopic internal fixation for pulmonary function recovery and prognosis in patients with multiple rib fractures and as...
AIM: This study aims to comparatively evaluate the ultra-minimally invasive rib fixation versus thoracoscopic internal fixation for pulmonary function recovery and prognosis in patients with multiple rib fractures and associated thoracic trauma. METHODS: This retrospective analysis included 120 patients with multiple rib fractures complicated by thoracic trauma admitted to Huai'an 82 Hospital between January 2020 and November 2024. Based on different surgical approaches, the patients were divided into a control group (n = 68), who received thoracoscopic internal fixation of rib fractures, and an observation group (n = 52) who underwent ultra-minimally invasive rib fracture fixation. Several surgical indices were comparatively assessed, including clinical efficacy, surgical parameters, complication rates, visual analogue scale (VAS) scores (pre- vs post-operation), pulmonary function tests, serum inflammatory marker levels, and quality of life assessments. RESULTS: The overall treatment efficacy between the observation and control groups [98.08% (51/52) vs 89.71% (61/68)] was not statistically significant (p = 0.146). The observation group had significantly shorter operation time, extubation time, time to ambulation, and hospitalization time than the control group, along with significantly reduced intraoperative bleeding (p < 0.001). The groups showed significant reductions in VAS scores at 12-h, 24-h, 48-h, and 72-h postoperatively compared to the preoperative baseline, with the observation group showing significantly lower scores than the control group at all time points (p < 0.05). Furthermore, significant increases in peak expiratory flow (PEF), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) were observed at 14 days after the procedure compared with their preoperative values, with the observation group indicating significantly higher values (p < 0.05). Similarly, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were substantially elevated in both groups at 48h postoperatively compared with their preoperative values; however, the observation group demonstrated significantly lower levels than the control group (p < 0.05). Three months after the procedure, both groups showed significant improvement in all eight areas of the 36-Item Short-Form Health Survey (SF-36) domains compared with preoperative values, with the observation group demonstrating significantly higher scores than the control group (p < 0.05). Additionally, the overall postoperative complications rate did not differ substantially between the two groups [13.46% (7/52) vs 16.18% (11/68); p = 0.680]. CONCLUSIONS: Compared with thoracoscopic internal fixation for multiple rib fractures complicated by thoracic trauma, ultra-minimally invasive rib fracture fixation offers clear advantages, including shorter operative time, reduced intraoperative bleeding, and faster postoperative recovery, while significantly improving pulmonary function and inflammatory marker levels.
Development of a Nomogram Using Lipid Profiles and Ultrasonic Thyroid Features as Potential Predictors of Postoperative Nausea and Vomiting After Thyroid Lobectomy.
Zhang X, Yu W, Wang Y
Ann Ital Chir · 2025 Dec · PMID 41399210 · Publisher ↗
AIM: This study aims to evaluate the predictive performance of preoperative blood lipid profiles combined with thyroid ultrasound features for postoperative nausea and vomiting (PONV) after thyroid lobectomy, and to deve...
AIM: This study aims to evaluate the predictive performance of preoperative blood lipid profiles combined with thyroid ultrasound features for postoperative nausea and vomiting (PONV) after thyroid lobectomy, and to develop a nomogram for individualized risk assessment. METHODS: This retrospective study included 269 patients who underwent thyroid lobectomy for nodular thyroid disease at the People's Hospital of Pingyang between January 2022 and December 2024. Study participants were divided into non-PONV (n = 102) and PONV (n = 167) groups. Preoperative clinical details, thyroid ultrasound parameters, and lipid profiles were compared between the two groups. Statistically significant variables (p < 0.05) from the univariate analysis were included in the multivariate logistic regression to identify independent risk predictors. A nomogram was constructed and internally validated using bootstrap resamples (1000 iterations). RESULTS: Multivariate analysis identified Apfel score, thyroid volume, maximum nodule diameter, presence of diffuse changes, total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL) as independent risk predictors of PONV. The nomogram showed favorable discriminative performance with an area under the receiver operating characteristic curve of 0.804 (95% CI: 0.749-0.859) and a bias-corrected area under the curve (AUC) of 0.794 (95% CI: 0.737-0.850) after bootstrap validation. Additionally, the model demonstrated favorable calibration and superior clinical utility, as assessed using the decision curve analysis. CONCLUSIONS: Multivariate analysis identified that preoperative blood lipid profiles and thyroid ultrasound features are independently associated with PONV. Incorporating these indicators along with established clinical risk factors into a nomogram enables accurate individualized prediction and may support targeted prophylactic interventions.
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