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Fibrinolytic responses of human peritoneal fluid in laparoscopic cholecystectomy: a prospective clinical study

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Abstract

Background

The reduction in peritoneal fibrinolysis is believed to be the pathogenetic mechanism of adhesion formation. The general conclusion based on previous clinical and experimental studies is that laparoscopic procedures produce less adhesion formation. The association between this beneficial effect of laparoscopic cholecystectomy and peritoneal fibrinolytic changes is not clear. Therefore, the authors aimed to compare the effects of open and laparoscopic cholecystectomy on peritoneal fibrinolysis. For this purpose, fibrinolytic parameters in peritoneal fluid were investigated 24 h after laparoscopic and open cholecystectomies.

Methods

In a prospective clinical study, peritoneal fluid was sampled via a drain 24 h after laparoscopic (n = 10) and open (n = 9) cholecystectomies. Activities and concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), and tPA/PAI-1 complex were determined by enzyme-linked immunosorbent assay (ELISA) kits.

Results

In peritoneal fluids, tPA and tPA/PAI-1 complex concentrations were higher in the open cholecystectomy group (p = 0.009 and p < 0.001, respectively), but tPA activity and PAI-1 concentrations did not differ between the groups (p = 0.514 and p = 0.716, respectively).

Conclusions

Fibrinolytic changes in peritoneal fluid have several similarities in open and laparoscopic cholecystectomies with regard to tPA activity and PAI-1 levels. However, higher tPA levels after the open procedure probably are secondary to more intense tissue handling leading to mesothelial release of tPA.

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Acknowledgment

The authors thank Mekin Sezik, M.D., from the Department of Obstetrics and Gynecology, Faculty of Medicine, Suleyman Demirel University, for language revisions. They also thank Mustafa Ozturk M.D., from the Department of Public Health, Faculty of Medicine, Suleyman Demirel University, for his assistance with the statistical analysis.

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Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey

    O. R. Tarhan, I. Barut, Y. Akdeniz, C. Cerci & M. Bulbul

  2. Department of Biochemistry, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey

    R. Sutcu

  3. Unikent Konut Kooperatifi, Mehmet Tonge Mahallesi. 23/A, Cunur, Isparta, Turkey

    O. R. Tarhan

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  1. O. R. Tarhan
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  2. I. Barut
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  3. Y. Akdeniz
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  4. R. Sutcu
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  5. C. Cerci
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  6. M. Bulbul
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Correspondence to O. R. Tarhan.

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Tarhan, O.R., Barut, I., Akdeniz, Y. et al. Fibrinolytic responses of human peritoneal fluid in laparoscopic cholecystectomy: a prospective clinical study. Surg Endosc 22, 1008–1013 (2008). https://doi.org/10.1007/s00464-007-9566-4

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  • DOI: https://doi.org/10.1007/s00464-007-9566-4

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