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Effect of laparoscopy and laparotomy on energy and protein metabolism in children: a randomized controlled trial
Merrill McHoney1, Simon Eaton, Angie Wade
1Department of Pediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
Insights
Laparoscopic surgery in children may alter energy metabolism compared to open surgery. These changes are linked to differences in intraoperative temperature regulation and protein breakdown.
Area of Science:
- Pediatric Surgery
- Metabolic Research
- Surgical Innovation
Background:
- Open surgery significantly impacts energy and protein metabolism in children.
- Understanding metabolic responses to different surgical approaches is crucial for pediatric patient care.
Purpose of the Study:
- To compare the effects of laparoscopic versus open Nissen fundoplication on energy and protein metabolism in pediatric patients.
- To investigate the influence of surgical technique on resting energy expenditure and protein breakdown.
Main Methods:
- Randomized controlled trial involving 41 pediatric patients undergoing Nissen fundoplication.
- Standardized anesthesia and postoperative care.
- Measurement of core temperature, respiratory gas exchange, resting energy expenditure (REE), and protein breakdown using stable isotopic leucine infusion.
Main Results:
- Laparoscopic surgery led to increased intraoperative core temperature and oxygen consumption compared to open surgery.
- Resting energy expenditure (REE) decreased postoperatively after open surgery but remained stable after laparoscopy.
- REE was higher at 4 hours postoperatively in the laparoscopic group; protein breakdown changes showed borderline significance between groups.
Conclusions:
- Laparoscopic surgery in children may result in altered energy metabolism compared to open procedures.
- Differences in intraoperative thermoregulation and protein breakdown during laparoscopy may contribute to these metabolic changes.
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.
