Surgical Stress after Open and Transumbilical Laparoscopic-Assisted Appendectomy in Children

Pietro Impellizzeri; Angela Simona; Maria Grasso; Pietro Antonuccio; Caterina Crisafi; Gianfranco Scalfari; Francesco Arena; Carmelo Salpietro; Mario Lima; Carmelo Romeo

doi:10.1055/s-0033-1333634

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2014; 24(02): 174-178
DOI: 10.1055/s-0033-1333634

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Surgical Stress after Open and Transumbilical Laparoscopic-Assisted Appendectomy in Children

Authors

Pietro Impellizzeri

¹Unit of Pediatric Surgery, Department of Pediatrics, Gynecological, Mycrobiological, and Biomedical Sciences, University of Messina, Messina, Italy
Angela Simona

¹Unit of Pediatric Surgery, Department of Pediatrics, Gynecological, Mycrobiological, and Biomedical Sciences, University of Messina, Messina, Italy
Maria Grasso

²Unit of Genetic and Pediatric Immunology, Department of Pediatric, Gynecological, Mycrobiological, and Biomedical Sciences, University of Messina, Messina, Italy
Pietro Antonuccio

¹Unit of Pediatric Surgery, Department of Pediatrics, Gynecological, Mycrobiological, and Biomedical Sciences, University of Messina, Messina, Italy
Caterina Crisafi

³Unit of Anesthesiology, University of Messina, Messina, Italy
Gianfranco Scalfari

¹Unit of Pediatric Surgery, Department of Pediatrics, Gynecological, Mycrobiological, and Biomedical Sciences, University of Messina, Messina, Italy
Francesco Arena

¹Unit of Pediatric Surgery, Department of Pediatrics, Gynecological, Mycrobiological, and Biomedical Sciences, University of Messina, Messina, Italy
Carmelo Salpietro

²Unit of Genetic and Pediatric Immunology, Department of Pediatric, Gynecological, Mycrobiological, and Biomedical Sciences, University of Messina, Messina, Italy
Mario Lima

⁴Unit of Pediatric Surgery, University of Bologna, Bologna, Italy
Carmelo Romeo

¹Unit of Pediatric Surgery, Department of Pediatrics, Gynecological, Mycrobiological, and Biomedical Sciences, University of Messina, Messina, Italy

Abstract

Introduction The transumbilical laparoscopic-assisted appendectomy (TULAA) effects on the surgical stress response in children have not been studied. Our aim is to investigate the stress response in TULAA.

Methods A total of 35 children underwent the appendectomy by open approach (OA) or TULAA approach. Interleukins (ILs)-6, -18, and -10 were measured before (T0), at the beginning (T1a), and at the end of surgery (T1b) and 24 hours after (T2).

Results An increase in IL-6 levels at T1b and T2 and in IL-18 at T2 was observed after OA. A significant increase of both IL-6 and IL-18 were observed at T2 but values were less compared with OA (11.6 ± 4.4 vs. 31.9 ± 8.9 pg/mL for IL-6, p = 0.0006; 145.6 vs. 174.9 pg/mL for IL-18, p = NS).

Conclusions A significant reduction in the postoperative cytokines in TULAA group suggests that this approach causes less surgical trauma in children.

Keywords

surgical stress - cytokines - transumbilical laparoscopic-assisted appendectomy - appendectomy

Full Text

References

References
1 Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc 1998; 12 (2) 177-178
2 Giannoudis PV, Dinopoulos H, Chalidis B, Hall GM. Surgical stress response. Injury 2006; 37: S3-S9
3 Romeo C, Cruccetti A, Turiaco A , et al. Monocyte and neutrophil activity after minor surgical stress. J Pediatr Surg 2002; 37 (5) 741-744
4 Cruickshank AM, Fraser WD, Burns HJ, Van Damme J, Shenkin A. Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci (Lond) 1990; 79 (2) 161-165
5 Li P, Xu Q, Ji Z , et al. Comparison of surgical stress between laparoscopic and open appendectomy in children. J Pediatr Surg 2005; 40 (8) 1279-1283
6 Pelosi MA, Pelosi III MA. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 1992; 37 (7) 588-594
7 Begin GF. Appendectomy in children by simple port laparoscopy. Chir Endosc 1993; 2: 6-9
8 Khosla A, Ponsky TA. Use of operative laparoscopes in single-port surgery: The forgotten tool. J Minim Access Surg 2011; 7 (1) 116-120
9 Valla J, Ordorica-Flores RM, Steyaert H , et al. Umbilical one-puncture laparoscopic-assisted appendectomy in children. Surg Endosc 1999; 13 (1) 83-85
10 Koontz CS, Smith LA, Burkholder HC, Higdon K, Aderhold R, Carr M. Video-assisted transumbilical appendectomy in children. J Pediatr Surg 2006; 41 (4) 710-712
11 Martino A, Zamparelli M, Cobellis G, Mastroianni L, Amici G. One-trocar surgery: a less invasive videosurgical approach in childhood. J Pediatr Surg 2001; 36 (5) 811-814
12 Suttie SA, Seth S, Driver CP, Mahomed AA. Outcome after intra- and extra-corporeal laparoscopic appendectomy techniques. Surg Endosc 2004; 18 (7) 1123-1125
13 Messina M, Garzi A, Molinaro F, Abate V, Nardi N. [Video-assisted trans-umbilical appendectomy: an effective and safe alternative in non-complicated appendicitis]. Minerva Chir 2005; 60 (2) 129-130
14 Meyer A, Preuss M, Roesler S, Lainka M, Omlor G. [Transumbilical laparoscopic-assisted “one-trocar” appendectomy—TULAA—as an alternative operation method in the treatment of appendicitis]. Zentralbl Chir 2004; 129 (5) 391-395
15 D'Alessio A, Piro E, Tadini B, Beretta F. One-trocar transumbilical laparoscopic-assisted appendectomy in children: our experience. Eur J Pediatr Surg 2002; 12 (1) 24-27
16 Giannoudis PV. Current concepts of the inflammatory response after major trauma: an update. Injury 2003; 34 (6) 397-404
17 Chalhoub V, Pottecher J, Asehnoune K, Mazoit JX, Duranteau J, Benhamou D. Cytokine response and reactive oxygen species production after low- and intermediate-risk surgery. Acta Anaesthesiol Scand 2011; 55 (5) 549-557
18 Napolitano LM, Ferrer T, McCarter Jr RJ, Scalea TM. Systemic inflammatory response syndrome score at admission independently predicts mortality and length of stay in trauma patients. J Trauma 2000; 49 (4) 647-652 , discussion 652–653
19 McHoney M, Eaton S, Wade A , et al. Inflammatory response in children after laparoscopic vs open Nissen fundoplication: randomized controlled trial. J Pediatr Surg 2005; 40 (6) 908-913 , discussion 913–914
20 Novitsky YW, Litwin DE, Callery MP. The net immunologic advantage of laparoscopic surgery. Surg Endosc 2004; 18 (10) 1411-1419
21 Luk JM, Tung PH, Wong KF, Chan KL, Law S, Wong J. Laparoscopic surgery induced interleukin-6 levels in serum and gut mucosa: implications of peritoneum integrity and gas factors. Surg Endosc 2009; 23 (2) 370-376
22 Giannoudis PV, Hildebrand F, Pape HC. Inflammatory serum markers in patients with multiple trauma. Can they predict outcome?. J Bone Joint Surg Br 2004; 86 (3) 313-323
23 Hansen TG, Tønnesen E, Andersen JB, Toft P, Bendtzen K. The peri-operative cytokine response in infants and young children following major surgery. Eur J Anaesthesiol 1998; 15 (1) 56-60
24 Nakamura M, Suita S, Yamanouchi T , et al. Cortisol and cytokine responses after surgery in different age groups of pediatric patients. Pediatr Surg Int 2003; 19 (3) 194-199
25 Sugama S, Conti B. Interleukin-18 and stress. Brain Res Brain Res Rev 2008; 58 (1) 85-95
26 Simon P, Burkhardt U, Sack U, Kaisers UX, Muensterer OJ. Inflammatory response is no different in children randomized to laparoscopic or open appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19 (Suppl. 01) S71-S76
27 Romeo C, Impellizzeri P, Antonuccio P , et al. Peritoneal macrophage activity after laparoscopy or laparotomy. J Pediatr Surg 2003; 38 (1) 97-101 , discussion 97–101
28 Montalto AS, Bitto A, Irrera N , et al. CO2 pneumoperitoneum impact on early liver and lung cytokine expression in a rat model of abdominal sepsis. Surg Endosc 2012; 26 (4) 984-989
29 Sido B, Teklote JR, Hartel M, Friess H, Büchler MW. Inflammatory response after abdominal surgery. Best Pract Res Clin Anaesthesiol 2004; 18 (3) 439-454
30 Hao W, Chan IH, Liu X, Tang PM, Tam PK, Wong KK. Early post-operative interleukin-6 and tumor necrosis factor-α levels after single-port laparoscopic varicocelectomy in children. Pediatr Surg Int 2012; 28 (3) 281-286