title: Inflammatory response is no different in children randomized to laparoscopic or open appendectomy.
abstract: BACKGROUND
  Previous studies suggest that the inflammatory response after laparoscopic appendectomy is less pronounced than after open surgery.
  
  
  OBJECTIVE
  To compare the clinical course and serum levels of a variety of immunoinflammatory markers in children randomized to either laparoscopic or open appendectomy for nonperforated appendicitis.
  
  
  METHODS
  Children with the diagnosis of appendicitis were randomized to either laparoscopicor open appendectomy after informed consent for participation in the study was obtained. Body temperature,leukocyte count, hematocrit and serum levels of the inflammatory markers c-reactive protein, interleukin (IL)-6, tumor necrosis factor (TNF)-, sTNF-R, IL-1Ra, sIL-2R, and IL-8 were determined at six different times: Before anesthesia induction, at skin incision, after wound closure, as well as 12, 24, and 72 hours postoperatively.Length of in-hospital stay was assessed as well. Parameters with normal distribution were compared by Student test for independent samples, all others were compared by the Mann-Whitney U test. P 0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 47 patients with appendicitis were recruited and randomized. Retrospectively, four patients in the open group and three in the laparoscopic group were excluded from the analysis because perforated appendicitis was described on their histopathologic report, leaving an equal number of patients in each study cohort(n = 20 each). There was no significant difference in demographic variables including age, body weight,and duration of symptoms. There were also no significant differences in body temperature, hematocrit, leukocytecount, or any of the inflammatory markers mentioned above. Average postoperative length of stay without any complications was 6.2 +/-2.5 days in the open group and 4.3 +/- 1.1 days in the laparoscopic group (P 0.01).
  
  
  CONCLUSIONS
  We found no differences in inflammatory parameters after open and laparoscopic appendectomy for nonperforated appendicitis. However, surgeons send their laparoscopically operated patients home earlier.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Simon
authors.forename: Ullrich
authors.initials: U
authors.lastname: Burkhardt
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sack
authors.forename: Udo X
authors.initials: UX
authors.lastname: Kaisers
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Muensterer
mesh_terms: D001062:Appendectomy / Q000379:methods; D015415:Biomarkers / Q000097:blood; D002648:Child; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D010535:Laparoscopy; D007902:Length of Stay; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers