ORIGINAL ARTICLE Inflammatory response after open and laparoscopic Nissen fundoplication in children: a randomized study Charlotte Kristensen Knatten • Claus H. B. Hviid • Are H. Pripp • Ragnhild Emblem • Kristin Bjørnland Accepted: 1 November 2013 / Published online: 16 November 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Purpose It is assumed that laparoscopic surgery gener- ally induces less inflammatory responses than open sur- gery. Since few studies have compared immune responses after laparoscopic and open surgery in children, we examined inflammatory markers in children randomized to open (ONF) or laparoscopic Nissen fundoplication (LNF). Methods Blood samples were collected prior to surgery (D0), and on postoperative day 1 (D1) and day 2 (D2). Inflammatory markers were measured using a multiplex antibody bead kit. The postoperative levels of inflamma- tory markers were statistically analyzed using a linear mixed model. A P value \ 0.05 was considered statistically significant. Results Twenty-nine patients randomized to ONF or LNF were included. Median age was 3.1 years (range 1.0–14.2) in the ONF group and 4.0 years (range 0.2–14.2) in the LNF group. Plasma levels of the anti-inflammatory cyto- kine interleukin (IL)-10 were significantly higher in the ONF group than in the LNF group postoperatively (P = 0.04). However, there were no significant differences between the groups in the levels of pro-inflammatory markers tumor necrosis factor-a, IL-6, IL-8, monocyte chemoattractant protein-1, white blood cell count, or C-reactive protein. Conclusions We did not find that laparoscopy induced a substantially less inflammatory response than laparotomy in children undergoing fundoplication. Keywords Inflammatory response Á Surgery Á Laparoscopy Á Fundoplication Introduction Laparoscopy has become the preferred technique for many abdominal surgical procedures in both children and adults [1]. Laparoscopy is assumed to be associated with less postoperative pain, fewer complications, shorter length of hospital stay, and better cosmetic results compared to the open technique [2–4]. Furthermore, laparoscopy is thought to cause less tissue trauma than laparotomy [5, 6]. Con- sequently, it has been assumed that laparoscopy induces less activation of the inflammatory system than laparotomy [7]. Confirming this hypothesis, an attenuated inflamma- tory response in adults has been reported in many studies comparing laparoscopy and laparotomy [8–11]. The inflammatory response after laparoscopy and lapa- rotomy has not been studied as thoroughly in children as in adults [12–15]. In children, laparoscopy seems to have a larger impact on urine output, cardiac output, and acid– base balance than open surgery [6, 7, 16–20]. These find- ings contrast those from trials in adults, where the physi- ological responses to laparoscopy are less pronounced. Moreover, cytokine levels in healthy children differ from C. K. Knatten and C. H. B. Hviid have contributed equally to this work and share first authorship. C. K. Knatten Á C. H. B. Hviid Á R. Emblem Á K. Bjørnland Faculty of Medicine, University of Oslo, 0316 Oslo, Norway C. K. Knatten (&) Á R. Emblem Á K. Bjørnland Department of Pediatric Surgery, Oslo University Hospital HF Rikshospitalet, Nydalen, Post box 4950, 0424 Oslo, Norway e-mail: charlotte@knatten.org C. H. B. Hviid Institute for Surgical Research, Oslo University Hospital Rikshospitalet, 0424 Oslo, Norway A. H. Pripp Unit of Biostatistics and Epidemiology, Oslo University Hospital Ulleva ˚l, 0424 Oslo, Norway 123 Pediatr Surg Int (2014) 30:11–17 DOI 10.1007/s00383-013-3433-2