Abstract
Introduction: Intraperitoneal adhesions are common after abdominal surgery and may lead to serious clinical complications. Previous studies have investigated the possible effects of the polypeptides poly-L-lysine (αPL) and poly-L-glutamate (PG) forming a polymer complex that prohibits local peritoneal adhesions after surgery. The aim of this study was to examine whether the normal process of peritoneal healing was affected by PL/PG polymer matrix. Material and methods: Male rats (Sprague Dawley) (n=84) underwent abdominal wall surgery and suturing. Rats were randomized in groups according to evaluation time (2, 4, 6, 8, 24 hours and 7 days) with corresponding control groups. Controls received saline (0.9%) and the experimental groups received PL/PG on the surgery site. tPA, PAI-1, IL-6 and active TGFb1 were analyzed at given time points postoperatively in peritoneal lavage. Adhesions were evaluated after seven days. Significant differences were considered to be p<0.05. Results: At a few individual time points small differences were seen between the groups (control and experiment) comparing levels of tPA, PAI-1, IL-6 and active TGFb1. When comparing levels of substances from all time points no statistical differences were seen between the groups as a total. Adhesions were significantly decreased on day 7, p=0.002. Conclusion: Despite significant reduction in adhesions PL/PG administered intraperitoneally as an anti-adhesion agent locally on surgically traumatized area does not seem to affect the normal process of peritoneal healing.
Highlights
Intraperitoneal adhesions are common after abdominal surgery and may lead to serious clinical complications
Components from coagulation tissue plasminogen activator, plasminogen activator inhibitor (PAI-1) and cytokines transforming growth factor beta (TGFb1) and interleukin-6 (IL-6) are examples of important and central factors involved in the formation of adhesions. tPa is the major initiator of fibrinolysis through the serine protease plasmin
In this study we demonstrated that there were no significant differences in fibrotic or inflammatory factors as measured by tissue plasminogen activator (tPA), PAI-1, TGF-b and IL-6 in peritoneal fluid, between the control group and the PL/PG group, before and after surgery
Summary
Intraperitoneal adhesions are common after abdominal surgery and may lead to serious clinical complications. During abdominal surgery the trauma involving mesothelial cells and submesothelial area cause changes that might lead to stable adhesions [2,3]. The formation of adhesions is believed to begin with local hypoxia at the site of the peritoneal injury, leading to the release of inflammatory cells (macrophages and neutrophils) from local damaged capillaries followed by fibrin depositions, decreased fibrinolysis and the proliferation of local and remote fibroblasts and mesothelial cells, contributing to increased fibrosis and eventually to stable fibrin strands that are replaced by collagen polymers [4,5,6,7,8]. Components from coagulation tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1) and cytokines transforming growth factor beta (TGFb1) and interleukin-6 (IL-6) are examples of important and central factors involved in the formation of adhesions. PAI-1, TGFb1 and IL-6 are important substances involved in peritoneal damage and healing and have the capacity to reduce the local peritoneal fibrinolysis [9,10,11]
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