The correlation of adhesions and peritoneal fluid cytokine concentrations: a pilot study.
BACKGROUND
Intra-abdominal adhesion formation and reformation after surgery is a significant cause of morbidity. The greatest problem after the surgical removal of adhesions is their reformation. We examined the concentrations of interleukin (IL)-1, IL-6 and tumour necrosis factor (TNF)-alpha in the peritoneal fluid throughout the 48 h post-operative period following adhesiolysis, and correlated the results to the extent of adhesion reformation.


METHODS
Peritoneal fluid, collected from eight patients following laparoscopy and again at 12, 36 and 48 h after surgery, was analysed using enzyme-linked immunosorbent assay (IL-1 and IL-6) and bioassay (TNF-alpha). At 48 h, a second look laparoscopy was performed to inspect the pelvis for adhesion formation/reformation.


RESULTS
Three patients had adhesion reformation >10% at 48 h after surgery. The mean adhesion score 48 h after adhesiolysis was 5 (range 0-17). The mean reduction in adhesion score was 88% (range 83-100%). Newly formed adhesions were filmy, relatively soft and avascular in nature. Adhesion reformation of >10% was associated with (i) high concentrations of IL-6 at 12 h (P < 0.01) and (ii) high concentrations of IL-1 at 48 h (P < 0.001).


CONCLUSIONS
Results from this preliminary study suggest that future treatment strategies for adhesion prevention could be aimed at the control of cellular mediators in the peritoneal fluid during the initial adhesion formation period.
Cheong
Y C
YC
Section of Reproductive and Developmental Medicine, The Jessop Wing, Central Sheffield University Hospitals, Tree Root Walk, Sheffield S10 2SF, UK.
Laird
S M
SM
Shelton
J B
JB
Ledger
W L
WL
Li
T C
TC
Cooke
I D
ID
D000328:Adult; D001202:Ascitic Fluid / Q000378:metabolism*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007375:Interleukin-1 / Q000378:metabolism*; D015850:Interleukin-6 / Q000378:metabolism*; D010535:Laparoscopy; D009994:Osmolar Concentration; D010532:Peritoneal Diseases / Q000378:metabolism* / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies; D055502:Secondary Prevention; D000267:Tissue Adhesions / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha