Laparoscopic Nissen fundoplication with carbon dioxide pneumoperitoneum preserves cell-mediated immunity in an immature animal model

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.