Immune response after laparoscopic and conventional Nissen fundoplication

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Abstract
Objective: To compare the changes in the immune responses of patients undergoing laparoscopic or conventional Nissen fundoplication. Design: Prospective randomised clinical study. Setting: University hospital, Finland. Subjects: 20 patients undergoing Nissen fundoplication for symptomatic erosive oesophagitis. Intervention: Laparoscopic Nissen fundoplication (n = 10) or conventional open Nissen fundoplication (n = 10). Main outcome measures: Leucocyte and differential counts; percentages of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD20 positive lymphocytes); and monocytes (CD14); phytohemagglutinin, concanavalin A and pokeweed mitogen‐induced and unstimulated proliferation of separated lymphocytes; plasma interleukin‐6 (IL‐6), serum C‐reactive protein (CRP), albumin, and cortisol concentrations; and group II phospholipase A2 (PLA2) activity. Results: Laparoscopic fundoplication was associated with less tissue damage (IL‐6, and CRP concentrations) than the conventional open operation. However, although there were pronounced changes in immune responses over time, there were no differences between the groups. Conclusion: Laparoscopic fundoplication seemed to cause less tissue damage than the conventional open operation, but this difference was not reflected in patients' immune responses. Copyright © 1999 Taylor and Francis Ltd.

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