A role for the fibrinolytic system in postsurgical adhesion formation.
OBJECTIVE
To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation.


METHODS
Retrospective and prospective study.


METHODS
University medical center.


METHODS
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.


METHODS
During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected.


METHODS
Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions.


RESULTS
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).


CONCLUSIONS
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.
Hellebrekers
Bart W J
BW
Department of Obstetrics and Gynecology, Haga Ziekenhuis, Leyenburg Hospital, The Hague, The Netherlands. bwjh@xs4all.nl
Emeis
Jef J
JJ
Kooistra
Teake
T
Trimbos
J Baptist
JB
Moore
Norma R
NR
Zwinderman
Koos H
KH
Trimbos-Kemper
Trudy C M
TC
D000328:Adult; D001202:Ascitic Fluid / Q000737:chemistry; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D006801:Humans; D010535:Laparoscopy; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011446:Prospective Studies; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000032:analysis
D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; D010959:Tissue Plasminogen Activator