A role for the fibrinolytic system in postsurgical adhesion formation

B W J Hellebrekers, J J Emeis, T Kooistra, J B Trimbos, N R Moore, K H Zwinderman, T C M Trimbos-Kemper

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objective: To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation.

Design: Retrospective and prospective study.

Setting: University medical center.

Patient(s): 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.

Intervention(s): During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected.

Main Outcome Measure(s): Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions.

Result(s): 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).

Conclusion(s): 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. (C)2005 by American Society for Reproductive Medicine.

Original languageEnglish
Pages (from-to)122-129
Number of pages8
JournalFertility and Sterility
Volume83
DOIs
Publication statusPublished - 2005

Keywords

  • adhesion formation
  • endometriosis
  • infertility surgery
  • early second-look laparoscopy
  • fibrinolytic system
  • ACTIVATOR INHIBITOR TYPE-1
  • PERITONEAL-FLUID
  • ENDOMETRIOSIS
  • SURGERY
  • DISEASE
  • TRAUMA

Cite this

Hellebrekers, B. W. J., Emeis, J. J., Kooistra, T., Trimbos, J. B., Moore, N. R., Zwinderman, K. H., & Trimbos-Kemper, T. C. M. (2005). A role for the fibrinolytic system in postsurgical adhesion formation. Fertility and Sterility, 83, 122-129. https://doi.org/10.1016/j.fertnstert.2004.06.060

A role for the fibrinolytic system in postsurgical adhesion formation. / Hellebrekers, B W J ; Emeis, J J ; Kooistra, T ; Trimbos, J B ; Moore, N R ; Zwinderman, K H ; Trimbos-Kemper, T C M .

In: Fertility and Sterility, Vol. 83, 2005, p. 122-129.

Research output: Contribution to journalArticle

Hellebrekers, BWJ, Emeis, JJ, Kooistra, T, Trimbos, JB, Moore, NR, Zwinderman, KH & Trimbos-Kemper, TCM 2005, 'A role for the fibrinolytic system in postsurgical adhesion formation', Fertility and Sterility, vol. 83, pp. 122-129. https://doi.org/10.1016/j.fertnstert.2004.06.060
Hellebrekers BWJ, Emeis JJ, Kooistra T, Trimbos JB, Moore NR, Zwinderman KH et al. A role for the fibrinolytic system in postsurgical adhesion formation. Fertility and Sterility. 2005;83:122-129. https://doi.org/10.1016/j.fertnstert.2004.06.060
Hellebrekers, B W J ; Emeis, J J ; Kooistra, T ; Trimbos, J B ; Moore, N R ; Zwinderman, K H ; Trimbos-Kemper, T C M . / A role for the fibrinolytic system in postsurgical adhesion formation. In: Fertility and Sterility. 2005 ; Vol. 83. pp. 122-129.
@article{e90908a354b84ae9bfe6477339f4bb85,
title = "A role for the fibrinolytic system in postsurgical adhesion formation",
abstract = "Objective: To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation.Design: Retrospective and prospective study.Setting: University medical center.Patient(s): 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.Intervention(s): During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected.Main Outcome Measure(s): Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions.Result(s): 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).Conclusion(s): 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. (C)2005 by American Society for Reproductive Medicine.",
keywords = "adhesion formation, endometriosis, infertility surgery, early second-look laparoscopy, fibrinolytic system, ACTIVATOR INHIBITOR TYPE-1, PERITONEAL-FLUID, ENDOMETRIOSIS, SURGERY, DISEASE, TRAUMA",
author = "Hellebrekers, {B W J} and Emeis, {J J} and T Kooistra and Trimbos, {J B} and Moore, {N R} and Zwinderman, {K H} and Trimbos-Kemper, {T C M}",
year = "2005",
doi = "10.1016/j.fertnstert.2004.06.060",
language = "English",
volume = "83",
pages = "122--129",
journal = "Fertility and Sterility",
issn = "0015-0282",
publisher = "ACADEMIC PRESS INC ELSEVIER SCIENCE",

}

TY - JOUR

T1 - A role for the fibrinolytic system in postsurgical adhesion formation

AU - Hellebrekers, B W J

AU - Emeis, J J

AU - Kooistra, T

AU - Trimbos, J B

AU - Moore, N R

AU - Zwinderman, K H

AU - Trimbos-Kemper, T C M

PY - 2005

Y1 - 2005

N2 - Objective: To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation.Design: Retrospective and prospective study.Setting: University medical center.Patient(s): 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.Intervention(s): During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected.Main Outcome Measure(s): Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions.Result(s): 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).Conclusion(s): 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. (C)2005 by American Society for Reproductive Medicine.

AB - Objective: To look for evidence of a fibrinolytic insufficiency as a cause of adhesion formation.Design: Retrospective and prospective study.Setting: University medical center.Patient(s): 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.Intervention(s): During all surgical procedures, adhesions were scored, and peritoneal fluid and plasma were collected.Main Outcome Measure(s): Parameters of the fibrinolytic system were measured to establish a possible relation with the presence and formation of adhesions.Result(s): 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).Conclusion(s): 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. (C)2005 by American Society for Reproductive Medicine.

KW - adhesion formation

KW - endometriosis

KW - infertility surgery

KW - early second-look laparoscopy

KW - fibrinolytic system

KW - ACTIVATOR INHIBITOR TYPE-1

KW - PERITONEAL-FLUID

KW - ENDOMETRIOSIS

KW - SURGERY

KW - DISEASE

KW - TRAUMA

U2 - 10.1016/j.fertnstert.2004.06.060

DO - 10.1016/j.fertnstert.2004.06.060

M3 - Article

VL - 83

SP - 122

EP - 129

JO - Fertility and Sterility

JF - Fertility and Sterility

SN - 0015-0282

ER -