Role of fibrinolysis in the formation of postoperative adhesions

It has been hypothesized that peritoneal hypofibrinolysis is of importance in the formation of postoperative adhesions, but results from experiments with fibrinolytic modulators are conflicting. We tested this hypothesis in a controlled prospective study in rabbits, comparing the effects of fibrinolytic inhibition (tranexamic acid) to fibrinolysis enhancement by local instillation of gel containing tissue‐type plasminogen activator. Adhesion formation was measured after 1 week in a strictly standardized way and is presented as a percentage of an induced lesion that was covered by adhesions. Fibrinolytic inhibition significantly increased adhesion formation, both to the parietal peritoneum (34.2%± 3.2%) compared with untreated control (19.7%± 3.3%, p < 0.01) and to the bowel (76.3%± 5.8%) compared with untreated control (51.2%± 8.7%, p < 0.05). Control gel significantly increased adhesions to the parietal peritoneum (35.6%± 4.6%) versus untreated control (19.7%± 3.3%, p < 0.05), whereas gel containing tissue‐type plasminogen activator significantly reduced the amount of adhesions to the parietal peritoneum (4.9%± 1.7%) compared with untreated control (19.7%± 3.3%, p < 0.01) and abolished adhesion formation to the injured bowel. The fibrinolytic system thus seems to be intimately involved in the early formation of intraabdominal adhesions.

[1]  B. Risberg,et al.  Experimental models for quantitative studies on adhesion formation in rats and rabbits. , 1994, European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes.

[2]  M. Mohler,et al.  Effect of varying days of tissue plasminogen activator therapy on the prevention of postsurgical adhesions in a rabbit model. , 1993, The Journal of surgical research.

[3]  D. Evans,et al.  Dose dependency and wound healing aspects of the use of tissue plasminogen activator in the prevention of intra-abdominal adhesions. , 1993, American journal of surgery.

[4]  F. Montz,et al.  The ability of recombinant tissue plasminogen activator to inhibit post-radical pelvic surgery adhesions in the dog model. , 1991, American journal of obstetrics and gynecology.

[5]  H. Ellis,et al.  The role of plasminogen activator in adhesion prevention. , 1991, Surgery, gynecology & obstetrics.

[6]  G. diZerega,et al.  Inhibition of postsurgical adhesions in a standardized rabbit model: intraperitoneal treatment with tissue plasminogen activator. , 1991, International journal of fertility.

[7]  R. Veldhuizen,et al.  Prevention of postoperative adhesions by tissue-type plasminogen activator (t-PA) in the rabbit. , 1990, European journal of obstetrics, gynecology, and reproductive biology.

[8]  R. Dunn,et al.  Tissue-type plasminogen activator as an adjuvant for post surgical adhesions. , 1990, Progress in clinical and biological research.

[9]  J. Thompson,et al.  Reduced human peritoneal plasminogen activating activity: Possible mechanism of adhesion formation , 1989, The British journal of surgery.

[10]  K. Doody,et al.  Recombinant tissue plasminogen activator reduces adhesion formation in a rabbit uterine horn model. , 1989, Fertility and sterility.

[11]  B. Risberg,et al.  Measurement of tissue plasminogen activator in plasma. A comparison of 3 methods and description of a new improved technique. , 1987, Thrombosis research.

[12]  O. Reikerås,et al.  Use of dextran to prevent intraperitoneal adhesions caused by maize starch powder. , 1985, European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes.

[13]  A. Rivkind,et al.  Urokinase does not prevent abdominal adhesion formation in rats. , 1985, European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes.

[14]  L. Häggroth,et al.  Inhibition of the human tissue plasminogen activator in plasma from different species. , 1984, Thrombosis research.

[15]  K. Robbins,et al.  Comparative activation kinetics of mammalian plasminogens. , 1983, Biochimica et biophysica acta.

[16]  A. Birkenfeld,et al.  The effect of urokinase in the prevention of intraperitoneal adhesions; role of blood in their formation. , 1983, Annales chirurgiae et gynaecologiae.

[17]  S. Lindenberg,et al.  Peritoneal dialysis reduces intraperitoneal adhesion formation. An experimental study in rats. , 1982, European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes.

[18]  H. L. Young,et al.  The effect of intravenous aprotinin (Trasylol) on intraperitoneal adhesion formation in the rat , 1981, The British journal of surgery.

[19]  M. Habal,et al.  Peritoneal adhesions: prevention with the use of hydrophilic polymer coatings. , 1980, Archives of surgery.

[20]  S. Renvall Peritoneal metabolism and intra-abdominal adhesion formation during experimental peritonitis. , 1980, Acta chirurgica Scandinavica. Supplementum.

[21]  A. Raftery Noxythiolin (Noxyflex), aprotinin (Trasylol) and peritoneal adhesion formation: An experimental study in the rat , 1979, The British journal of surgery.

[22]  S. Perovic,et al.  Prophylaxis of Adhesions with Trasylol in Cases of Perforated Appendicitis in Children , 1978, The Journal of international medical research.

[23]  O. Gilmore,et al.  Noxytiolin and peritoneal adhesion formation , 1976, The British journal of surgery.

[24]  R. Buckman,et al.  A unifying pathogenetic mechanism in the etiology of intraperitoneal adhesions;. , 1976, The Journal of surgical research.

[25]  M. Weibel,et al.  Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. , 1973, American journal of surgery.

[26]  M. Irfan Fibrinolytic activity in animals of different species. , 1968, Quarterly journal of experimental physiology and cognate medical sciences.

[27]  H. Myllärniemi Foreign material in adhesion formation after abdominal surgery. A clinical and experimental study. , 1967, Acta chirurgica Scandinavica. Supplementum.

[28]  T. Hugh,et al.  The effect of streptokinase on experimental intraperitoneal adhesion formation. , 1965, The Journal of pathology and bacteriology.

[29]  J. Knightly,et al.  The effect of fibrinolysin and heparin on the formation of peritoneal adhesions. , 1962, Surgery.

[30]  H. Ellis,et al.  The aetiology of post‐operative abdominal adhesions an experimental study , 1962, The British journal of surgery.