Original ArticleEffect of Laparoscopy and Laparotomy on Energy and Protein Metabolism in Children: A Randomized Controlled Trial
Section snippets
Methods
Children undergoing Nissen fundoplication for gastroesophageal reflux were included in the study. Patients with clinical suspicion of sepsis (symptoms or signs of infection associated with fever or increased white blood cell count or C-reactive protein level) or cardiac, renal, immunological, or metabolic abnormalities were excluded. Fully informed written consent was obtained. The study was approved by the local research ethics committee. Patients were randomized to laparotomy or laparoscopy
Results
Sixty-eight patients were assessed for entry into the trial; 44 patients were randomized, and 41 patients proceeded through the trial protocol. After excluding patients for various reasons (Figure 1; available at www.jpeds.com), 16 open and 16 laparoscopic patients had REE measurements taken. Patient demographics were similar in both groups; operation length was significantly longer in the laparoscopy group (Table I). There was no difference in REE in groups in the preoperative period (P =
Discussion
In this randomized controlled trial of Nissen fundoplication in children, open and laparoscopic surgery had different effects on whole body energy and protein metabolism. Intraoperative CT and were higher during laparoscopy. Postoperatively REE fell in the open group, but was unchanged after laparoscopy. The laparoscopic group had a consistent rise in REE 4 hours postoperatively. Protein breakdown was also preserved 4 hours after laparoscopy compared with open surgery. Length of operation
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Supported by Sport Aiding medical Research for Kids (SPARKS), which had no role in the study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the manuscript for publication. The authors declare no conflicts of interest.
ClinicalTrials.gov Identifier: NCT00231543.