Decreased peritoneal tissue plasminogen activator during prolonged laparoscopic surgery.
BACKGROUND
Peritoneal fibrinolysis is crucial in the peritoneal healing processes and subsequent adhesion formation. During conventional surgery, the peritoneal fibrinolytic system is rapidly disturbed. Short-term laparoscopy does not seem to affect peritoneal fibrinolysis. The aim of the present study was to assess the effect of prolonged laparoscopic surgery on peritoneal fibrinolysis.


METHODS
Twelve consecutive patients undergoing laparoscopic gastric bypass surgery for morbid obesity were included in the study. During the procedure, biopsies of the parietal peritoneum were taken at the start of the procedure and each 45 min afterward. Tissue samples were homogenized and tissue-type plasminogen activator (tPA) antigen, tPA activity, urokinase-type PA antigen, and plasminogen activating inhibitors type 1 antigen were measured using commercial assay techniques.


RESULTS
Both tPA antigen and its activity progressively decreased during the procedure, reaching significant levels after 90 min of surgery. The levels of uPA antigen and plasminogen activating inhibitors antigen did not significantly change throughout the procedure.


CONCLUSIONS
As for conventional surgery, prolonged laparoscopic surgery causes a decreased fibrinolytic activity in the peritoneum due to decreased tPA levels.
Department of Surgery, Hospital Rijnstate, Arnhem, The Netherlands. w.brokelman@planet.nl
Walter J A
WJ
Brokelman
Lena
L
Holmdahl
Ignace M C
IM
Janssen
Peter
P
Falk
Maria
M
Bergström
Jean H G
JH
Klinkenbijl
Michel M P J
MM
Reijnen
D000328:Adult; D001706:Biopsy; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010537:Peritoneum / Q000378:metabolism* / Q000473:pathology; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000378:metabolism*; D014568:Urokinase-Type Plasminogen Activator / Q000378:metabolism; D014945:Wound Healing / Q000502:physiology
D017395:Plasminogen Activator Inhibitor 1; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator