Inflammatory response after open and laparoscopic Nissen fundoplication in children: a randomized study.
OBJECTIVE
It is assumed that laparoscopic surgery generally induces less inflammatory responses than open surgery. Since few studies have compared immune responses after laparoscopic and open surgery in children, we examined inflammatory markers in children randomized to open (ONF) or laparoscopic Nissen fundoplication (LNF).


METHODS
Blood samples were collected prior to surgery (D0), and on postoperative day 1 (D1) and day 2 (D2). Inflammatory markers were measured using a multiplex antibody bead kit. The postoperative levels of inflammatory markers were statistically analyzed using a linear mixed model. A P value <0.05 was considered statistically significant.


RESULTS
Twenty-nine patients randomized to ONF or LNF were included. Median age was 3.1 years (range 1.0-14.2) in the ONF group and 4.0 years (range 0.2-14.2) in the LNF group. Plasma levels of the anti-inflammatory cytokine interleukin (IL)-10 were significantly higher in the ONF group than in the LNF group postoperatively (P = 0.04). However, there were no significant differences between the groups in the levels of pro-inflammatory markers tumor necrosis factor-α, IL-6, IL-8, monocyte chemoattractant protein-1, white blood cell count, or C-reactive protein.


CONCLUSIONS
We did not find that laparoscopy induced a substantially less inflammatory response than laparotomy in children undergoing fundoplication.
Faculty of Medicine, University of Oslo, 0316, Oslo, Norway, charlotte@knatten.org.
Charlotte Kristensen
CK
Knatten
Claus H B
CH
Hviid
Are H
AH
Pripp
Ragnhild
R
Emblem
Kristin
K
Bjørnland
D000293:Adolescent; D002097:C-Reactive Protein; D018932:Chemokine CCL2 / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005748:Gastric Fundus / Q000601:surgery; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D010535:Laparoscopy / Q000379:methods*; D007958:Leukocyte Count / Q000706:statistics & numerical data; D008297:Male; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D018932:Chemokine CCL2; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein