TY - JOUR
T1 - Immune response
T2 - Effects of operative stress in a pediatric model
AU - Mendoza-Sagaon, Mario
AU - Gitzelmann, Christopher A.
AU - Herreman-Suquet, Karen
AU - Pegoli, Walter
AU - Talamini, Mark A.
AU - Paidas, Charles N.
N1 - Funding Information:
From the Division of Pediatric Surgery the Department of Surgery, The Johns Hopkins Universily School of Medicine, Baltimore, MD. Presented at the 2&h Annual Meetirzg of the American Pediatric Surgical Association, Naples, Florida, May 18-21, 1997. This study has been supported in part by the Robert Garrett Research Fund (Baltimore, MD). Christopher A. Gitzelmann is supported in part by the Swiss National Research Foundation (Bern, Switzerland). Address reprint requests to Charles N. Paidas, MD, The Johns Hopkins Hospital, Division of Pediatric Surgery, 600 N Wolfe St, CMSC 7-119, Baltimore, MD 21287. Copyright 0 1998 by WB. Saunders Company 0022.3468/98/3302-0047$03.00/O group. Statistically significant differences were found in postoperative days 1, 4, and 5 between laparoscopy and laparotomy. The laparoscopy group showed a statistically significant decrease in DTH skin induration on postoperative day 2 when compared with the control group. At postoperative day7 and 8 there was no statistical difference in DTH skin response comparing baseline values or between groups.
PY - 1998/2
Y1 - 1998/2
N2 - Purpose: The purpose of this study is to delineate the effect of different operative procedures on the cell-mediated immune response in a pediatric animal model using the delayed type hypersensitivity (DTH) skin test. Methods: Sprague Dawley rats (1 week old) were sensitized against keyhole limpet hemocyanin (KLH). Animals were challenged 2 weeks later by an intradermal injection of KLH (0.3 mg) in sterile saline. Rats with positive DTH skin reactions at 24 and 48 hours after challenge (baseline) were divided randomly into five groups (n = 10 each): group I, unmanipulated control; group II, anesthesia; group III, anesthesia and midline extraperitoneal incision; Group IV, anesthesia and laparoscopy (pneumoperitoneum with carbon dioxide); Group V, anesthesia and midline laparotomy. Before each procedure (day 0) and on postoperative days 3 and 6, animals were again challenged intradermally with KLH (0.3 mg). DTH skin reaction was evaluated 24 and 48 hours later. Results: A statistically significant difference (P < .05) in DTH skin reaction at 24 and 48 hours was observed between postoperative days 1 to 5 in the extraperitoneal and laparotomy groups with respect to baseline and the control group. Statistically significant differences were found in postoperative days 1, 4, and 5 between laparoscopy and laparotomy. The laparoscopy group showed a statistically significant decrease in DTH skin induration on postoperative day 2 when compared with the control group. At postoperative day 7 and 8 there was no statistical difference in DTH skin response comparing baseline values or between groups. Conclusions: These results suggest that in a pediatric animal model, abdominal surgical procedures accompanied by extensive tissue dissection produce a cellular immunosuppression, lasting up to 7 days, which is not observed in less invasive procedures. Observations concerning lesser immunosuppressive effects of laparoscopy when compared with laparotomy in adult models, as previously described by our laboratory, were also found in this pediatric model.
AB - Purpose: The purpose of this study is to delineate the effect of different operative procedures on the cell-mediated immune response in a pediatric animal model using the delayed type hypersensitivity (DTH) skin test. Methods: Sprague Dawley rats (1 week old) were sensitized against keyhole limpet hemocyanin (KLH). Animals were challenged 2 weeks later by an intradermal injection of KLH (0.3 mg) in sterile saline. Rats with positive DTH skin reactions at 24 and 48 hours after challenge (baseline) were divided randomly into five groups (n = 10 each): group I, unmanipulated control; group II, anesthesia; group III, anesthesia and midline extraperitoneal incision; Group IV, anesthesia and laparoscopy (pneumoperitoneum with carbon dioxide); Group V, anesthesia and midline laparotomy. Before each procedure (day 0) and on postoperative days 3 and 6, animals were again challenged intradermally with KLH (0.3 mg). DTH skin reaction was evaluated 24 and 48 hours later. Results: A statistically significant difference (P < .05) in DTH skin reaction at 24 and 48 hours was observed between postoperative days 1 to 5 in the extraperitoneal and laparotomy groups with respect to baseline and the control group. Statistically significant differences were found in postoperative days 1, 4, and 5 between laparoscopy and laparotomy. The laparoscopy group showed a statistically significant decrease in DTH skin induration on postoperative day 2 when compared with the control group. At postoperative day 7 and 8 there was no statistical difference in DTH skin response comparing baseline values or between groups. Conclusions: These results suggest that in a pediatric animal model, abdominal surgical procedures accompanied by extensive tissue dissection produce a cellular immunosuppression, lasting up to 7 days, which is not observed in less invasive procedures. Observations concerning lesser immunosuppressive effects of laparoscopy when compared with laparotomy in adult models, as previously described by our laboratory, were also found in this pediatric model.
KW - Cellular immunosuppression
KW - Laparoscopy
KW - Postoperative stress
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U2 - 10.1016/S0022-3468(98)90469-9
DO - 10.1016/S0022-3468(98)90469-9
M3 - Article
C2 - 9498424
AN - SCOPUS:0031939719
SN - 0022-3468
VL - 33
SP - 388
EP - 393
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 2
ER -