Inflammatory response in children after laparoscopic vs open Nissen fundoplication: randomized controlled trial.
We performed a randomized controlled trial to compare the inflammatory and immune responses to Nissen fundoplication in infants and children undergoing either open or laparoscopic surgery.


METHODS
Forty children undergoing Nissen fundoplication were randomized to laparoscopy or open surgery using minimization with respect to age, neurologic status, and operating surgeon. Intraoperative and postoperative analgesias were standardized. Inflammatory markers (plasma malondialdehyde, nitrate plus nitrite level, and cytokines) and monocyte class II major histocompatibility complex expression were measured preoperatively, at end of surgery, 4, 24, and 48 hours postoperatively. Postoperative changes were compared between open and laparoscopic groups.


RESULTS
There were no significant changes in circulating malondialdehyde, nitrates plus/ nitrite, interleukin-10, or tumor necrosis factor alpha in the postoperative period in either group. Interleukin-1 receptor antagonist (IL-1rA) and IL-6 were significantly increased in both groups, with a tendency for greater elevation of IL-1rA in the open group. Monocyte major histocompatibility complex expression fell significantly in both groups; however, this fall appeared to be slightly more marked in the open group.


CONCLUSIONS
The postoperative cytokine response is similar in children undergoing open and laparoscopic Nissen fundoplication. This trial indicates that laparoscopy may partly reduce postoperative immune suppression.
Department of Paediatric Surgery, Institute of Child Health, Great Ormond Street Hospital, London, England, WC1N1EH, UK.
Merrill
M
McHoney
Simon
S
Eaton
Angie
A
Wade
Nigel J
NJ
Klein
Giorgio
G
Stefanutti
Clare
C
Booth
Edward M
EM
Kiely
Joseph I
JI
Curry
David P
DP
Drake
Agostino
A
Pierro
D002648:Child; D016207:Cytokines / Q000097:blood*; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005802:Genes, MHC Class II / Q000276:immunology; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000517:prevention & control; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects*; D008315:Malondialdehyde / Q000097:blood; D009566:Nitrates / Q000097:blood; D009569:Nitric Oxide / Q000378:metabolism; D009573:Nitrites / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D017472:Receptors, Interleukin-1 / Q000097:blood; D012795:Sialoglycoproteins / Q000097:blood
D016207:Cytokines; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6; D009566:Nitrates; D009573:Nitrites; D017472:Receptors, Interleukin-1; D012795:Sialoglycoproteins; D009569:Nitric Oxide; D008315:Malondialdehyde