Expression and kinetics of fibrinolytic components in plasma and peritoneum during abdominal surgery

Objective: A reduced peritoneal tissue fibrinolytic capacity is thought to be pathogenetic in intra-abdominal adhesion formation. Therefore, the aim of this study was to characterize the expression of fibrinolytic components in peritoneal tissue and peripheral blood at the beginning and end of abdominal surgery. Design: Peripheral blood and peritoneal tissue were sampled simultaneously from consecutive patients operated for non-septic causes (Group 1, n = 27) or for intra-abdominal infections (Group 2, n = 10). Setting. Surgical department, University hospital. Subjects. Thirty-seven surgical patients. Interventions. Abdominal surgery. Main outcome measures: Tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor type-1 (PAI-1) and the inactive complex formation between t-PA and PAI-1 were assayed in plasma and peritoneal tissue extracts sampled at the beginning and end of surgery. Results: The expression of fibrinolytic components in plasma was similar in the two groups when surgery commenced. However, the intraoperative response was partly different. In Group 1, significant increases in t-PA antigen, PAI-I antigen and t-PA/PAI complex were observed during surgery as opposed to Group 2. When surgery started, Group 2 displayed a reduced fibrinolytic capacity in peritoneal tissue compared with Group 1. In the latter, there was a rapid decline in t-PA activity, followed by an increase in uPA, PAI-1 and t-PA-PAI complex. The changes in Group 2 were similar, but attenuated. There was no correlation in concentrations of fibrinolytic parameters between peritoneal and blood samples. Conclusion: These observations provide novel insights into the early systemic and tissue response to surgery and may lead to new therapeutic strategies.