The Peritoneal Fibrinolytic Response to Conventional and Prolonged Surgery Is Similar

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We are pleased to comment on this interesting article by Brokelman et al. [ 1 Brokelman W.J. Holmdahl L. Janssen I.M. et al. Decreased peritoneal tissue plasminogen activator during prolonged laparoscopic surgery. J Surg Res. 2009; 151: 89 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar ], which furthers our current understanding of the peritoneal environment during laparoscopic surgery. The authors demonstrate that prolonged laparoscopic surgery leads to a reduction in peritoneal fibrinolytic activity due to decreased levels of tissue plasminogen activator (tPA). These results are similar to those observed with conventional or open surgery, where a reduction in peritoneal fibrinolysis has already been demonstrated [ 2 Holmdahl L. Eriksson E. Eriksson B.I. et al. Depression of peritoneal fibrinolysis during operation is a local response to trauma. Surgery. 1998; 123: 539 Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar ]. Interestingly, the authors previously showed that short-term (<45 min) laparoscopic procedures do not affect peritoneal fibrinolysis [ 3 Brokelman W.J. Holmdahl L. Bergstrom M. et al. Peritoneal fibrinolytic response to various aspects of laparoscopic surgery: A randomized trial. J Surg Res. 2006; 136: 309 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar ], and may not cause new adhesion formation. Since reduced peritoneal fibrinolysis is thought to significantly contribute to adhesion formation, any method, technical, pharmacologic or otherwise, that maintains or elevates postoperative levels of peritoneal tPA would be beneficial in the management of postoperative adhesions.