The impact of gas laparoscopy on abdominal plasminogen activator activity.
BACKGROUND
The impairment of intestinal perfusion following induction of a pneumoperitoneum may lead to a reduction of peritoneal tissue plasminogen activator (tPA) activity and a concomitant increased risk of adhesion formation.


METHODS
Pigs were laparotomized to take peritoneal biopsy specimens from the cecum, the ileum, and the abdominal wall. A 15 mmHg pneumoperitoneum was established for 3 h by the insufflation of carbon dioxide (group 2, n = 6) or helium (group 3, n = 6). Group 1 (n = 7) received no gas insufflation. After a 2-h recovery period, additional tissue samples were harvested. Specific tPA activity was then determined in the tissue extracts.


RESULTS
During surgery, specific tPA activity decreased in all the samples. As compared with the control group (100%), this reduction was strongly aggravated in the cecum (-67.6%, p < 0.05) and the ileum (-70.8%) of the CO2 group but only slightly aggravated in the helium group. The parietal peritoneum was not specifically affected by gas insufflation.


CONCLUSIONS
The use of a pneumoperitoneum with carbon dioxide significantly affects peritoneal tPA activity and thus may represent a stimulus for adhesion formation.
Nagelschmidt
M
M
Second Department of Surgery, Biochemical and Experimental Division, University of Cologne, Ostmerheimer Strasse 200, 51109 Cologne, Germany.
Gerbecks
D
D
Minor
T
T
D000818:Animals; D001706:Biopsy; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000009:adverse effects; D002432:Cecum / Q000378:metabolism* / Q000473:pathology; D006371:Helium / Q000008:administration & dosage; D007082:Ileum / Q000378:metabolism* / Q000473:pathology; D007327:Insufflation; D007410:Intestinal Diseases / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D010537:Peritoneum / Q000378:metabolism / Q000473:pathology; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D013152:Splanchnic Circulation; D013552:Swine; D000267:Tissue Adhesions / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000378:metabolism*
D002245:Carbon Dioxide; D006371:Helium; D010959:Tissue Plasminogen Activator