Peritoneal fibrinolytic activity and adhesiogenesis
S. Gradinaru Fometescu, M. Costache, A. Coveney, S.M. Oprescu, D. Serban, C. SavlovschiOriginal article, no. 3, 2013
Introduction: Postoperative adhesions after abdominal or pelvic
surgery remain an important clinical problem causing
infertility, pain and bowel obstruction. Their prevention and
treatment remains poorly understood and inadequate. The
formation of adhesions is caused by the organization of a
fibrin matrix, an organization that takes place during the
coagulation process when there is suppression of fibrinolysis.
Methods: In this study peritoneal tissue and peritoneal fluid
from two groups of patients were sampled and analysed. The
first group comprised of 12 patients undergoing abdominal
surgery for an acute abdomen during which known peritoneal
factors of aggression (trauma, chemical, bacterial) were present
which are known to increase the propensity for peritoneal
adhesion formation. A second group consisting of 6 patients
undergoing surgery in the absence of these peritoneal
aggression factors acted as a reference control group. Each patient had peritoneal tissue sampled at the time of surgery
and analysed for levels of gene expression of tissue plasminogen
activator (tPA) and plasminogen activator inhibitor-1
(PAI-1). Patients also had peritoneal drain fluid collected postoperatively
and analysed for quantities of fibrin degradation
products (FDPs) and fibrinogen.
Results: The aim of this study was to evaluate the role of
PAI-1 and tPA genes at peritoneal tissue level. Peritoneal
tissue was obtained during surgery and the variation of
expression of PAI-1 and tPA genes was quantified. The
obtained results highlighted an increase of expression in
PAI-1 gene and decrease of expression in tPA gene in
patients with increased factors of peritoneal aggression
compared to patients without, indicating a decreased
fibrinolytic potential in patients with increased peritoneal
adhesion propensity. Increased factors of peritoneal
aggression also resulted in increased levels of FDPs and
fibrinogen in peritoneal exudates.
