Morphology, quality, and composition in mature human peritoneal adhesions.
OBJECTIVE
Peritoneal adhesions are caused by intra-abdominal surgery and can lead to relevant complications. Adhesions are supposed to consist of avascular scar tissue. The aim of the present study was to analyze whether mature postsurgical adhesions even after years still reveal a dynamic remodeling process.


METHODS
In a prospective analysis, we investigated tissue specimen of peritoneal adhesions in 40 patients after abdominal surgery. Expression of five parameters representing wound healing and remodeling were examined (MMP-2, Ki-67, apoptosis, collagen/protein ratio, and collagen type I/III ratio).


RESULTS
Gender, age, and the number of previous operations had no impact on the parameters measured. Adhesion specimens were cell rich, containing mononuclear round cells, fibroblasts, adipose cells, and vascular endothelial cells. There was a positive expression of MMP-2 and apoptosis, whereas Ki-67 was marginal irrespective of adhesion maturity or quality. Adhesions classified as dense showed a significant increase in total collagen (118.2 +/- 4.9 microg/mg) and collagen type I/III ratios (3.9 +/- 0.2), whereas there were no significant differences regarding the adhesion maturity.


CONCLUSIONS
The distinct composition of cellular components as well as of extracellular matrix proteins may reflect an interactive cross-talk between adhesion- and stroma-derived cells even in mature adhesions. Our findings support the hypothesis that the disabilities of appropriate repair of the peritoneal surface leading to persistent adhesions are a consequence of a permanent process of disturbed remodeling.
Binnebösel
Marcel
M
Department of Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany. mbinneboesel@ukaachen.de
Klinge
Uwe
U
Rosch
Rafael
R
Junge
Karsten
K
Lynen-Jansen
Petra
P
Schumpelick
Volker
V
D000328:Adult; D000368:Aged; D017209:Apoptosis / Q000502:physiology; D003094:Collagen / Q000032:analysis; D024042:Collagen Type I / Q000032:analysis; D024061:Collagen Type III / Q000032:analysis; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D007124:Immunoenzyme Techniques; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000032:analysis; D008859:Microscopy, Polarization; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000473:pathology* / Q000601:surgery; D010537:Peritoneum / Q000473:pathology* / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology* / Q000601:surgery; D012038:Regeneration / Q000502:physiology; D012086:Reoperation; D012704:Serous Membrane / Q000473:pathology / Q000601:surgery; D000267:Tissue Adhesions / Q000473:pathology / Q000601:surgery; D014945:Wound Healing / Q000502:physiology
D024042:Collagen Type I; D024061:Collagen Type III; D019394:Ki-67 Antigen; D003094:Collagen; D020778:Matrix Metalloproteinase 2