M. Mendoza-sagaon et al., Laparoscopic Nissen fundoplication with carbon dioxide pneumoperitoneum preserves cell-mediated immunity in an immature animal model, J PED SURG, 36(10), 2001, pp. 1564-1568
Purpose: The aim of this study is to elucidate the effects of laparoscopic
Nissen fundoplication (LNF) with carbon dioxide (CO2) or helium (He) on the
cell-mediated immune response in a pediatric animal model compared with op
en Nissen fundoplication (ONF).
Methods: Cell immune response was evaluated in 45 1-week-old Sprague Dawley
rats using the delayed type hypersensitivity (DTH) skin test. Animals were
sensitized against keyhole limpet hemocyanin (KLH) by subcutaneous injecti
on (0.5 mg) in complete Freund's adjuvant. Animals were challenged 2 weeks
later by an intradermal injection of KLH (0.3 mg) in sterile saline (challe
nge 1, baseline). Rats with positive DTH skin reaction at 24 and 48 hours a
fter challenge 1 were put randomly into 4 groups (n = 10 each): I, only ane
sthesia (control); II, LNF with CO2, III, LNF with He; IV, ONF. Animals wer
e injected intradermally with KLH (0.3 mg) immediately before the procedure
s (challenge 2) and 3 and 6 days postoperatively (challenges 3 and 4).
Results: DTH skin reactions were measured 24 and 48 hours after each challe
nge. There were no significant changes in cell-mediated immunosuppression a
fter LNF with CO2. However, a transient cell-mediated immunosuppression was
observed after LNF with He and ONF. All fundoplications were intact at the
time of necropsy.
Conclusions: These data suggest a transient suppression of cell-mediated im
munity in open procedures when compared with laparoscopic interventions usi
ng CO2 in a pediatric animal model. In addition, the type of gas used durin
g laparoscopy also may modulate this transient immunosuppression. Copyright
(C) 2001 by W.B. Saunders Company.