A prospective randomized study of the systemic immune response after laparoscopic and conventional Nissen fundoplication.
BACKGROUND
Laparoscopic techniques are thought to reduce the postoperative immunologic and metabolic changes of conventional operations. Until now, the only clinical data available were obtained from patients operated on for symptomatic gallstones; moreover, few studies were randomized. This randomized prospective study compares the systemic immune response after laparoscopic and conventional Nissen fundoplication.


METHODS
Seventeen patients scheduled for Nissen fundoplication were randomly assigned to undergo either a laparoscopic or a conventional procedure. Postoperative inflammatory response was assessed by measuring the white blood cell count, C-reactive protein, and soluble tumor necrosis factor receptors p55 and p75. Postoperative immune function was assessed by measuring monocyte HLA-DR expression and the stress response was assessed by measuring plasma cortisol concentrations.


RESULTS
Laparoscopic surgery resulted in significantly lower plasma CRP levels 1 day after surgery. Both approaches resulted in a significant decrease in HLA-DR expression within 2 hours after surgery. After the laparoscopic approach, postoperative expression was restored to preoperative values within 1 day after surgery. However, after conventional surgery HLA-DR expression remained suppressed and did not return to preoperative values until the fourth postoperative day. No significant differences between the 2 procedures were observed in white cell blood count, sTNFr-p55 and p75, nor in postoperative cortisol levels.


CONCLUSIONS
Although both laparoscopic and conventional Nissen fundoplication result in an activation of the systemic immune response, this study suggests that this response could be less after the laparoscopic approach. The differences found may reflect a lower risk for postoperative infective complications.
Sietses
C
C
Department of Surgery, Faculty of Medicine, Amsterdam, The Netherlands.
Wiezer
M J
MJ
Eijsbouts
Q A
QA
Beelen
R H
RH
van Leeuwen
P A
PA
von Blomberg
B M
BM
Meijer
S
S
Cuesta
M A
MA
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D018662:Fundoplication; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007109:Immunity; D010535:Laparoscopy; D007958:Leukocyte Count; D008875:Middle Aged; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000032:analysis
D006684:HLA-DR Antigens; D018124:Receptors, Tumor Necrosis Factor; D002097:C-Reactive Protein; D006854:Hydrocortisone