Preservation of peritoneal fibrinolysis owing to decreased transcription of plasminogen activator inhibitor-1 in peritoneal mesothelial cells suppresses postoperative adhesion formation in laparoscopic surgery

• Published in: Surgery Vol. 153; no. 3; pp. 344 - 356
• Main Authors: Shimomura, Manabu, MD, Hinoi, Takao, MD, Ikeda, Satoshi, MD, Adachi, Tomohiro, MD, Kawaguchi, Yasuo, MD, Tokunaga, Masakazu, MD, Sasada, Tatsunari, MD, Egi, Hiroyuki, MD, Tanabe, Kazuaki, MD, Okajima, Masazumi, MD, Ohdan, Hideki, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.03.2013
• Subjects: Aged; Animals; Cautery - adverse effects; Cecum - surgery; Female; Fibrinolysis - genetics; Gastrectomy - adverse effects; Gastrectomy - methods; Humans; Laparoscopy - adverse effects; Male; Middle Aged; Peritoneum - metabolism; Plasminogen Activator Inhibitor 1 - genetics; Plasminogen Activator Inhibitor 1 - metabolism; Pneumoperitoneum, Artificial - adverse effects; Prospective Studies; Rats; Rats, Inbred F344; RNA, Messenger - genetics; RNA, Messenger - metabolism; Surgery; Tissue Adhesions - genetics; Tissue Adhesions - metabolism; Tissue Adhesions - prevention & control; Tissue Plasminogen Activator - genetics; Tissue Plasminogen Activator - metabolism; Transcription, Genetic
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2012.07.037

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. Conclusion 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.