title: Preservation of peritoneal fibrinolysis owing to decreased transcription of plasminogen activator inhibitor-1 in peritoneal mesothelial cells suppresses postoperative adhesion formation in laparoscopic surgery.
abstract: BACKGROUND
  Postoperative adhesion formation is regulated by peritoneal fibrinolysis, which is determined by tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1). This study compared peritoneal fibrinolysis and adhesion formation after laparoscopic surgery (LAP) and open surgery (OP).
  
  
  METHODS
  We divided 154 male rats into 3 groups after cecal cauterization: Control, no treatment; LAP, CO2 pneumoperitoneum at 5 mmHg for 60 minutes; and OP, laparotomy for 60 minutes. Adhesions were quantified at day 7. The activity and mRNA level of tPA and PAI-1 were determined by enzyme-linked immunosorbent assay in plasma and peritoneal lavage and by real-time polymerase chain reaction in peritoneal mesothelial cells from omentum. We also examined peritoneal fibrinolysis in human gastric cancer patients treated with LAP (n = 14) or OP (n = 10).
  
  
  RESULTS
  In the animal study, adhesion scores, PAI-1 activity in peritoneal lavage fluid, and PAI-1 mRNA levels in peritoneal mesothelium were significantly greater in the OP group than the control and LAP groups. In the human study, postoperative PAI-1 mRNA levels were significantly greater in the OP group than the LAP group. Additionally, PAI-1 mRNA levels and subsequent adhesion formation were induced by prolonged operative time in the OP group, but not the LAP group.
  
  
  CONCLUSIONS
  Preservation of peritoneal fibrinolysis owing to decreased PAI-1 expression at the transcriptional level in peritoneal mesothelial cells is associated with suppression of postoperative adhesion formation in LAP. PAI-1 mRNA levels and subsequent adhesion formation were not induced by prolonged operative time in LAP. These results highlight the less invasiveness nature of LAP.
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Shimomura
authors.forename: Takao
authors.initials: T
authors.lastname: Hinoi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikeda
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Adachi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Tatsunari
authors.initials: T
authors.lastname: Sasada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Egi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Tanabe
authors.forename: Masazumi
authors.initials: M
authors.lastname: Okajima
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
mesh_terms: D000368:Aged; D000818:Animals; D002425:Cautery / Q000009:adverse effects; D002432:Cecum / Q000601:surgery; D005260:Female; D005342:Fibrinolysis / Q000235:genetics; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000378:metabolism*; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics* / Q000378:metabolism; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011446:Prospective Studies; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D051381:Rats; D011916:Rats, Inbred F344; D000267:Tissue Adhesions / Q000235:genetics / Q000378:metabolism / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000235:genetics / Q000378:metabolism; D014158:Transcription, Genetic
chemical_list: D017395:Plasminogen Activator Inhibitor 1; D012333:RNA, Messenger; D010959:Tissue Plasminogen Activator