Immune response after laparoscopic and conventional Nissen fundoplication

Objective: To compare the changes in the immune responses of patients undergoing laparoscopic or conventional Nissen fundoplication. Design: Prospective randomised clinical study. Setting: University hospital, Finland. Subjects: 20 patients undergoing Nissen fundoplication for symptomatic erosive oesophagitis. Intervention: Laparoscopic Nissen fundoplication (n = 10) or conventional open Nissen fundoplication (n = 10). Main outcome measures: Leucocyte and differential counts; percentages of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD20 positive lymphocytes); and monocytes (CD14); phytohemagglutinin, concanavalin A and pokeweed mitogen-induced and unstimulated proliferation of separated lymphocytes; plasma interleukin-6 (IL-6), serum C-reactive protein (CRP), albumin, and cortisol concentrations; and group II phospholipase A(2) (PLA(2)) activity. Results: Laparoscopic fundoplication was associated with less tissue damage (IL-6, and CRP concentrations) than the conventional open operation. However, although there were pronounced changes in immune responses over time, there were no differences between the groups. Conclusion: Laparoscopic fundoplication seemed to cause less tissue damage than the conventional open operation, but this difference was not reflected in patients' immune responses.