A role for the fibrinolytic system in postsurgical adhesion formation

Hellebrekers BW, Bart W J Hellebrekers, J.J. Emeis, Emeis JJ, Jef J Emeis, Teake Kooistra, Kooistra T, J Baptist Trimbos, Trimbos JB, Moore NR, Norma R Moore, Zwinderman KH, Koos H Zwinderman, Koos Zwinderman, Trudy C M Trimbos-Kemper, Trimbos-Kemper TC
Fertility and Sterility · 2005 · vol. 83(1) , pp. 122–129 · doi:10.1016/j.fertnstert.2004.06.060 · PMID:15652897 · W2111690159
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This paper investigates the involvement of the fibrinolytic system in the development of adhesions that can occur after surgery.

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Abstract

ObjectiveTo look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation.DesignRetrospective and prospective study.SettingUniversity medical center.Patient(s)Retrospective study: 50 patients undergoing laparoscopy, divided into patients with and without endometriosis. Prospective study: 18 patients undergoing infertility surgery involving a second-look laparoscopy.Intervention(s)During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected.Main outcome measure(s)Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions.Result(s)In patients with endometriosis and adhesions, significantly higher peritoneal fluid concentrations were found for plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), and plasminogen, compared with patients with endometriosis but without adhesions. In the prospective study, initial peritoneal PAI-1 concentrations correlated significantly with the extent of adhesion formation (r(s) = 0.49) and adhesion-improvement scores (r(s) = -0.52). Also, the change in concentration of tPA and fibrinogen from the initial surgical procedure to the second-look laparoscopy correlated significantly with adhesion-improvement scores (DeltatPA: r(s)= 0.50; Deltafibrinogen: r(s) = -0.64).Conclusion(s)This first prospective study in humans adds further weight to the hypothesis that adhesions are caused by an insufficiency in peritoneal fibrinolytic activity. Plasminogen activator inhibitor-1 is a potential marker for the identification of patients at risk for developing adhesions.

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MeSH descriptors

Fibrinolysis Tissue Adhesions Adult Ascitic Fluid Ascitic Fluid Female Fibrin Fibrinogen Degradation Products Fibrin Fibrinogen Degradation Products Humans Laparoscopy Plasminogen Activator Inhibitor 1 Plasminogen Activator Inhibitor 1 Prospective Studies Retrospective Studies Tissue Adhesions Tissue Plasminogen Activator Tissue Plasminogen Activator

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