Abstract
Peritoneal commissures is the phenomenon of adhesions formation with apparent symptom group of violations in functioning of the gastrointestinal tract and small pelvis. Unlike other postoperative complications adhesive disease is characterized by high risk for life manifestations in the form of intestinal obstruction, infertility and chronic pain. It is known that in the process of restoring the integrity of the peritoneum the decisive role is given to makrophages, peritoneal immune system, processes of angiogenesis, increasing fibroblasts and collagen production. However, the biochemical processes taking place in the intercellular matrix of connective tissue, particularly, the exchange of glycosaminoglycans in the formation of peritoneal adhesions have not been studied. In this context, the main objective of this work was to study levels of glycosaminoglycans of the blood in the development of adhesive disease and justification of the use of indicators to exchange connective tissue as additional prognostic criteria for the development of postoperative adhesions. An open prospective randomized trial analyzed the data of 67 patients that were admitted for the planned reconstructive surgery on the anterior abdominal wall to eliminate postoperative ventral hernia, at the surgery department of State Clinical Hospital No. 8, city ofUFAduring the period of 2005-2008. The severity of adhesions was assessed and contrasted to the results of determination of glycosaminoglycans in blood serum. The total content of glycosaminoglycans, hyaluronic acid, chondroitin sulfates and heparan sulfates was determined. Postoperative monitoring stages of the studied indicators -3, 5 and 7 day after herniotomy. The group of patients with adhesive peritoneum desease showed total content of glycosaminoglycans by 19.2% (p < 0.0001) higher than reference values. It should be noted that there was continuous growth of all factions of glycosaminoglycans during all seven days of the postoperative monitoring. The growth of the overall content of the glycosaminoglycans made 261% (p < 0.0001) compared with the control group. Method of ROC-analysis established that the area under the ROC curve is a common glycosaminoglycans is equal 0.824 ± 0.055, 95% confidence interval-0.906 0.711. Sensitivity-70.4% (54.8 -86.0), specificity is 97.5% (82.4 -98.6). The optimum point for the division amounted to 30 μmol/l. Positive predicting level amounted to 96.8%, negative 75.1%. Thus, the assessment of the level of glycosaminoglycans can serve as an additional prognostic test to diagnose disturbance in intercellular matrix that can be used in the diagnosis of commissural process and in monitoring the effectiveness of preventive measures.
Highlights
Гликозаминогликаны в составе протеогликанов соединительной ткани обеспечивают ее механичес
Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after nongynaecological abdominal surgery
Summary
Comment on: correlations between intra-abdominal pressure and obesity-related co-morbidities. 8. Malbrain ML, De Keulenaer BL, Oda J, De Laet I, De Waele JJ, Roberts DJ, et al Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine. Intra-abdominal pressure, acute kidney injury, and obesity in critical illness. The factor of intra-abdominal pressure in patients with morbid obesity. Host remodelling of the gut microbiome and metabolic changes during pregnancy. Microinflammation, metabolic profile, and zonulin concentration in obese and normal weight subjects. Role of the gut in multiple organ failure: bacterial translocation and permeability changes.
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