Download PDF
Eur J Pediatr Surg 2010; 20(1): 29-34
DOI: 10.1055/s-0029-1241875
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of a Possible Inflammatory Response after Appendectomy for Non-Perforated Appendicitis in Children

F. Serour1 , 2 , A. Herman2 , I. Babai3 , A. Gorenstein1 , 2 , N. Gershon1 , E. Somekh4 , 2 , I. Dalal4 , 2
  • 1The E. Wolfson Medical center, Department of Pediatric Surgery, Holon, Israel
  • 2Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  • 3The E. Wolfson Medical Center, Clinical Immunology Laboratory, Holon, Israel
  • 4The E. Wolfson Medical Center, Pediatric Infectious/Allergy/Immunology Unit, Holon, Israel
Further Information

Publication History

received September 04, 2009

accepted after revision September 06, 2009

Publication Date:
28 October 2009 (online)

    Permissions and Reprints

Abstract

background: The inflammatory process in the post-appendectomy period is not well characterized. In a pilot study, we prospectively followed the kinetics of different inflammatory mediators before and after appendectomy in children, and compared the results of the groups open appendectomy (OA) and laparoscopic appendectomy (LA).

Material and Methods: Levels of sP-selectin, tPA, MCP-1, IL-6, IL-8, sVCAM-1, and sCD40L were measured before appendectomy and on the next three consecutive days in the serum of 25 children (16 males and 9 females) aged 7 – 16 years (mean 12.6±2.47 years) with non-perforated acute appendicitis.

Results: LA and OA were performed in 16 and 9 patients respectively. None of the markers of inflammation differed significantly by surgical approach at any point of observation. However, sP-selectin, MCP-1 and sVCAM-1 levels were found to have significantly different postoperative kinetics with a trend towards higher values in the laparoscopic group compared to the open appendectomy group (p=0.034, p=0.016 and p=0.025, respectively).

Conclusions: The cytokines sP-selectin, MCP-1 and sVCAM-1 may play a role in the possible post-appendectomy cytokine activation after non-perforated appendicitis. Since this phenomenon is more evident after LA than after OA, the contribution of the different LA procedures has to be further investigated.

Key words

appendicitis - children - cytokines - inflammation - laparoscopic appendectomy

References

  • 1 Abbas AK. Effector mechanisms of immune responses. In: Abbas AK, Lichtman AH, Pober JS. Cellular and Molecular Immunobiology. Philadelphia: WB Saunders 2000 pp: 233-339
    Google Scholar
  • 2 Bergmann S, Hammerschmidt S. Fibrinolysis and host response in bacterial infections.  Thromb Haemost. 2007;  98 512-520
    Google Scholar
  • 3 Bittinger F, Brochhausen C, Köhler H. Differential expression of cell adhesion molecules in inflamed appendix: correlation with clinical stage.  J Pathol. 1998;  186 422-428
    Google Scholar
  • 4 Bloechle C, Kluth D, Holstein AF. A pneumoperitoneum perpetuates severe damage to the ultrastructural integrity of parietal peritoneum in gastric perforation-induced peritonitis in rats.  Surg Endosc. 1999;  13 683-688
    Google Scholar
  • 5 Eriksson S, Granstrom L, Olander B. et al . Sensitivity of interleukin-6 and C-reactive protein concentrations in the diagnosis of acute appendicitis?.  Eur J Surg. 1995;  161 41-45
    Google Scholar
  • 6 Erkasap S, Ates E, Ustuner Z. Diagnostic value of interleukin-6 and C-reactive protein in acute appendicitis.  Swiss Surg. 2000;  6 169-172
    Google Scholar
  • 7 Faraway J. Extending the Linear Model with R.  Chapman and Hall/CRC. 2006;  233-234
    Google Scholar
  • 8 Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation.  N Engl J Med. 1999;  340 448-454
    Google Scholar
  • 9 Glasgow RE, Fingerhut A, Hunter J. SAGES Appropriateness Conference: a summary.  Surg Endosc. 2003;  17 1729-1734
    Google Scholar
  • 10 Goodwin AT, Swift RI, Bartlett MJ. Can serum interleukin-6 levels predict the outcome of patients with right iliac fossa pain?.  Ann R Coll Surg Engl. 1997;  79 130-133
    Google Scholar
  • 11 Hastie T. Generalized Additive Models – R package, 2005; Version 0.94. 
    Google Scholar
  • 12 Ignacio RC, Burke R, Spencer D. Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial.  Surg Endosc. 2004;  18 334-337
    Google Scholar
  • 13 Kuebler JF, Kos M, Jescha NK. et al . Carbon dioxide suppresses macrophage superoxide anion production independent of extracellular pH and mitochondrial activity.  J Pediatr Surg. 2007;  42 244-248
    Google Scholar
  • 14 Lehmann EL, Romano JP. Testing Statistical Hypotheses. New York: Springer 2005 pp: 513-517
  • 15 Mattioli G, Castagnetti M, Jasonni V. Appendicectomy for simple appendicitis: video-assisted or intracorporeal?.  J Laparoendosc Adv Surg Tech A. 2007;  17 478-482
    Google Scholar
  • 16 Moehrlen U, Schwöbel F, Reichmann E. et al . Early peritoneal macrophage function after laparoscopic surgery compared with laparotomy in a mouse model.  Surg Endosc. 2005;  19 958-963
    Google Scholar
  • 17 Neuhaus SJ, Watson DI. Pneumoperitoneum and peritoneal surface changes.  A review. Surg Endosc. 2004;  18 1316-1322
    Google Scholar
  • 18 Oka T, Kurkchubasche AG, Bussey JG. Open and laparoscopic appendectomy are equally safe and acceptable in children.  Surg Endosc. 2004;  18 242-245
    Google Scholar
  • 19 Prystowsky JB, Pugh CM, Nagle AP. Appendicitis.  Curr Probl Surg. 2005;  42 688-742
    Google Scholar
  • 20 R Development Core Team. .R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna: Austria ISBN 3-900051-07-0. Available at: http://www.r-project.org Accessed 16 November 2007
    Google Scholar
  • 21 Sacheck J. Pediatric obesity: an inflammatory condition?.  J Parenter Enteral Nutr. 2008;  32 633-637
    Google Scholar
  • 22 Sauerland S, Lefering R, Neugebauer EAM. Laparoscopic versus open surgery for suspected appendicitis.  Cochrane Database Syst Rev. 2004;  4 CD001546
    Google Scholar
  • 23 Serour F, Witzling M, Gorenstein A. Is laparoscopic appendectomy in children associated with an uncommon postoperative complication?.  Surg Endosc. 2005;  19 919-922
    Google Scholar
  • 24 Shimotakahara A, Kuebler JF, Vieten G. et al . Carbon dioxide directly suppresses spontaneous migration, chemotaxis, and free radical production of human neutrophils.  Surg Endosc. 2008;  22 1813-1817
    Google Scholar
  • 25 Springer TA. Adhesion receptors of the immune system.  Nature. 1990;  346 425-434
    Google Scholar
  • 26 Tsuji M, Puri P, Reen DJ. Characterisation of the local inflammatory response in appendicitis.  J Pediatr Gastroenterol Nutr. 1993;  16 43-48
    Google Scholar
  • 27 Ure BM, Niewoid TA, Bax NMA. et al . Peritoneal, systemic, and distant organ inflammatory responses are reduced by a laparoscopic approach and carbon dioxide vs air.  Surg Endosc. 2002;  16 836-842
    Google Scholar
  • 28 Venables WN, Ripley BD. Modern Applied Statistics with S-PLUS. 3rd ed. New York: Springer-Verlag 1999 pp. 285-289
  • 29 Volz J, Koster S, Spacek Z. Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum.  Surg Endosc. 1999;  13 611-614
    Google Scholar
  • 30 Wilks SS. The large-sample distribution of the likelihood ratio for testing composite hypotheses.  Annals of Mathematical Statistics. 1938;  9 60-62
    Google Scholar
  • 31 Zeillemaker AM, Hoynck van-Papendrecht AA, Hart, D. Peritoneal interleukin-8 in acute appendicitis.  J Surg Res. 1996;  62 273-277
    Google Scholar

Correspondence

Dr. Francis SerourMD 

The E. Wolfson Medical center

Department of Pediatric Surgery

62 Halokhamim Street

58100 Holon

Israel

Phone: +97/235/02 84 19

Fax: +97/235/02 81 86

Email: serour@wolfson.health.gov.il

      >