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

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 c...

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Bibliographic Details
Published in:The Journal of pediatrics 2010-09, Vol.157 (3), p.439-444.e2
Main Authors: McHoney, Merrill, PhD, FRCS, Eaton, Simon, PhD, Wade, Angie, PhD, Carnielli, Virgilio, MD, Kiely, Ed, FRCS, Drake, David, FRCS, Curry, Joe, FRCS, Pierro, Agostino, MD, FRCS
Format: Article
Language:English
Subjects:
Adolescent
Biological and medical sciences
Child
Child, Preschool
Digestive system. Abdomen
Double-Blind Method
Endoscopy
Energy Metabolism
Fundoplication - methods
General aspects
Humans
Infant
Investigative techniques, diagnostic techniques (general aspects)
Laparoscopy
Laparotomy
Medical sciences
Pediatrics
Proteins - metabolism
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Summary: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.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2010.02.067