TY - JOUR
T1 - A role for the fibrinolytic system in postsurgical adhesion formation
AU - Hellebrekers, Bart W. J.
AU - Emeis, Jef J.
AU - Kooistra, Teake
AU - Trimbos, J. Baptist
AU - Moore, Norma R.
AU - Zwinderman, Koos H.
AU - Trimbos-Kemper, Trudy C. M.
PY - 2005
Y1 - 2005
N2 - To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation. Retrospective and prospective study. University medical center. Retrospective study: 50 patients undergoing laparoscopy, divided into patients with and without endometriosis. Prospective study: 18 patients undergoing infertility surgery involving a second-look laparoscopy. During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected. Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions. In patients with endometriosis and adhesions, significantly higher peritoneal fluid concentrations were found for plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), and plasminogen, compared with patients with endometriosis but without adhesions. In the prospective study, initial peritoneal PAI-1 concentrations correlated significantly with the extent of adhesion formation (r(s) = 0.49) and adhesion-improvement scores (r(s) = -0.52). Also, the change in concentration of tPA and fibrinogen from the initial surgical procedure to the second-look laparoscopy correlated significantly with adhesion-improvement scores (DeltatPA: r(s)= 0.50; Deltafibrinogen: r(s) = -0.64). This first prospective study in humans adds further weight to the hypothesis that adhesions are caused by an insufficiency in peritoneal fibrinolytic activity. Plasminogen activator inhibitor-1 is a potential marker for the identification of patients at risk for developing adhesions
AB - To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation. Retrospective and prospective study. University medical center. Retrospective study: 50 patients undergoing laparoscopy, divided into patients with and without endometriosis. Prospective study: 18 patients undergoing infertility surgery involving a second-look laparoscopy. During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected. Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions. In patients with endometriosis and adhesions, significantly higher peritoneal fluid concentrations were found for plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), and plasminogen, compared with patients with endometriosis but without adhesions. In the prospective study, initial peritoneal PAI-1 concentrations correlated significantly with the extent of adhesion formation (r(s) = 0.49) and adhesion-improvement scores (r(s) = -0.52). Also, the change in concentration of tPA and fibrinogen from the initial surgical procedure to the second-look laparoscopy correlated significantly with adhesion-improvement scores (DeltatPA: r(s)= 0.50; Deltafibrinogen: r(s) = -0.64). This first prospective study in humans adds further weight to the hypothesis that adhesions are caused by an insufficiency in peritoneal fibrinolytic activity. Plasminogen activator inhibitor-1 is a potential marker for the identification of patients at risk for developing adhesions
U2 - https://doi.org/10.1016/j.fertnstert.2004.06.060
DO - https://doi.org/10.1016/j.fertnstert.2004.06.060
M3 - Article
C2 - 15652897
SN - 0015-0282
VL - 83
SP - 122
EP - 129
JO - Fertility and Sterility
JF - Fertility and Sterility
IS - 1
ER -