Abstract
Background:
The present study was performed to investigate the differences in lymphocyte subpopulations and HLA-DR expression on monocytes as markers for the systemic immune response in children undergoing either minimal invasive surgery (MIS) or conventional (open) surgery.
Methods:
In a prospective study we compared 20 children admitted for fundoplication or chest wall correction. The surgical access was decided based upon the individual anatomy. Postoperative inflammatory immune response was assessed for the MIS versus open group by measuring the level of C-reactive protein (CRP) and lymphocyte subpopulations (CD3, CD4, CD8, NK cells, CD25, and HLA-DR on monocytes) by a flow cytometer. Blood samples were collected preoperatively and 12, 24, 72 h, and 7 days after surgery.
Results:
Postoperatively in the open surgery group a significantly greater increase of CRP was recorded. Open surgery, but not MIS, was found to cause a significant reduction of all lymphocyte subpopulations and HLA-DR on monocytes. A significant difference between the open and MIS groups was observed in the following cell subsets: CD3, CD4, and HLA DR expression on monocytes.
Conclusion:
Corresponding to the results in adults, elective surgery in children causes a temporary suppression of the immune system. MIS involves less alteration of the immune system in children than conventional operations and may be an indicator of reduced surgical trauma.
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