[Post-appendectomy immunologic competence in pediatric age. The results do not always match expectations. Laparoscopy versus laparotomy]

BACKGROUND: Impairment of immune function after surgery may be the main mechanism causing increased susceptibility to infection. In our study we evaluated the post-operative immunocompetence in pediatric patients, treated for acute appendicitis by laparotomy or by laparoscopy, with the intent to clarify the difference between the immune responses induced by two different surgical approaches. METHODS: Two groups of twenty children suffering from acute appendicitis were randomly allocated for laparoscopic or laparotomic surgery. Immunologic function was assessed by a count of lymphocyte subsets and monocytes expressing human leukocyte antigen DR (HLA-DR), using FITC or PE-labeled monoclonal antibodies and a FACScan cytofluorimeter. Blood samples were obtained immediately before the surgical therapy, and 2 and 8 days after therapy. For statistical analysis the continuous variables were compared by Student's t-Test. P values less than 0.05 were considered significant. RESULTS: In the post-operative period the counts of T-lymphocytes and monocytes expressing HLA-DR were similar in both groups. Overall, no statistically significant differences were observed; in particular, we did not find any impairment of immune function. CONCLUSIONS: This study demonstrates the lack of impairment of cell-mediated immune function after surgery in children treated by laparotomy and by laparoscopy. The physiological integrity of children can probably explain this finding, since in the case of adults numerous papers have reported an immunological depression, more pronounced after laparotomy than after laparoscopy.