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

OBJECTIVE: To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation. DESIGN: Retrospective and prospective study. SETTING: University 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 Fibrinolysis Tissue Adhesions Adult Adult Ascitic Fluid Ascitic Fluid Ascitic Fluid Female Female Fibrin Fibrinogen Degradation Products Fibrin Fibrinogen Degradation Products Fibrin Fibrinogen Degradation Products Humans Humans Laparoscopy Laparoscopy Plasminogen Activator Inhibitor 1 Plasminogen Activator Inhibitor 1 Plasminogen Activator Inhibitor 1

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