title: A role for the fibrinolytic system in postsurgical adhesion formation.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Haga Ziekenhuis, Leyenburg Hospital, The Hague, The Netherlands. bwjh@xs4all.nl
authors.forename: Bart W J
authors.initials: BW
authors.lastname: Hellebrekers
authors.forename: Jef J
authors.initials: JJ
authors.lastname: Emeis
authors.forename: Teake
authors.initials: T
authors.lastname: Kooistra
authors.forename: J Baptist
authors.initials: JB
authors.lastname: Trimbos
authors.forename: Norma R
authors.initials: NR
authors.lastname: Moore
authors.forename: Koos H
authors.initials: KH
authors.lastname: Zwinderman
authors.forename: Trudy C M
authors.initials: TC
authors.lastname: Trimbos-Kemper
mesh_terms: 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
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; D010959:Tissue Plasminogen Activator