Elsevier

The Journal of Pediatrics

Volume 157, Issue 3, September 2010, Pages 439-444.e2
The Journal of Pediatrics

Original Article
Effect of Laparoscopy and Laparotomy on Energy and Protein Metabolism in Children: A Randomized Controlled Trial

https://doi.org/10.1016/j.jpeds.2010.02.067Get rights and content

Objective

To compare the effects of surgery on energy and protein metabolism in children randomized to undergo laparoscopic and open surgery.

Study design

We randomized 41 patients to open or laparoscopic Nissen fundoplication. Anesthesia and postoperative management were standardized. We recorded core temperature, respiratory gas exchange preoperatively, intraoperatively, and 4 and 24 hours postoperatively and calculated resting energy expenditure (REE). Protein breakdown was measured by using stable isotopic leucine infusion preoperatively and 4 hours postoperatively.

Results

Intraoperative core temperature and oxygen consumption increased in the laparoscopic group compared with the open group. REE decreased in the early postoperative period in the open group, but did not decrease after laparoscopy. REE at 4 hours was higher after laparoscopy. Protein breakdown also decreased in the early postoperative period; the pattern of change between open and laparoscopic groups was of borderline significance.

Conclusions

Laparoscopy in children may alter the changes in energy metabolism observed after open surgery. These differences may be partially caused by alterations in intraoperative thermoregulation and protein breakdown during laparoscopy in children.

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 V˙O2 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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    • Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review

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      After assessing for predefined exclusion criteria, they enrolled 20 patients in the open and 19 patients in the laparoscopic group and adopted standard regimens for anesthesia, surgery, and postoperative feeding management. The study was powered to detect a difference in resting energy expenditure between the two surgical approaches, which was reported in a separate publication along with data on protein metabolism [31]. As a result, the study was underpowered to assess the clinical outcomes and showed no difference in dysphagia, GERD recurrence, or need for redo fundoplication between the open and laparoscopic approaches.

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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.

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