Ulus Travma Acil Cerrahi Derg. 2016; 22(1): 1-6 | DOI: 10.5505/tjtes.2015.95881

Effects of saline lavage temperature on peritoneal fibrinolysis and adhesion formation

Yavuz Savaþ Koca¹, Ömer Rýdvan Tarhan¹, Selçuk Kaya², Berit Gökçe Ceylan^3
1Department Of General Surgery, Faculty Of Medicine, Suleyman Demirel University, Isparta, Turkey.
²Department Of Medical Microbiology, Faculty Of Medicine, Suleyman Demirel University, Isparta, Turkey.
³Department Of Anesthesiology And Reanimationfaculty Of Medicine, Suleyman Demirel University, Isparta, Turkey.

Background
Peritoneal lavage with saline at room temperature causes peritoneal hypothermia, vasoconstriction, hypoxia, and acidosis. These effects are known to reduce fibrinolysis. Decreased fibrinolysis causes permanent adhesions. Normothermic lavage may prevent this deleterious process and reduces peritoneal adhesions.

Methods
A rat model of cecal abrasion was used. Control animals received no medication, while hypothermic or normothermic saline lavage were administered intraperitoneally to the experimental groups (n = 24 for each group). Cardinal parameters of peritoneal fibrinolysis (tissue plasminogen activator [tPA] and plasminogen activator inhibitor type 1 [PAI-1]) were determined in peritoneal tissue samples at the postoperative day 1, 3, and 10. At postoperative day 10 adhesions were graded. In the sham group (n=8), following laparotomy peritoneal samples were taken to determine basal values of tPA and PAI-1 in healthy peritoneum.

Results
Cecal abrasion increased PAI-1 levels about tenfold at postoperative day 1 and caused adhesions. Normothermic saline lavage prevented this traumatic PAI-1 increase and stabilized it to baseline values throughout the experiment and reduced peritoneal adhesion formation. Hypothermic lavage also caused an inhibition of PAI-1 rise but adhesion, prevention was not significant.

Conclusion
Our results suggest that normothermic saline lavage reduces adhesions by improving peritoneal fibrinolysis.

Keywords: Normothermic, Hypothermic, Peritoneal Lavage, Peritoneal Adhesion, Saline Solution, Tissue Plasminogen Activator, Plasminogen Activator Inhibitor 1

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Serum Fizyolojikle Yapýlan Lavaj Sýcaklýðýnýn Peritoneal Fibrinoliz ve Adezyon Geliþimine Etkisi

Yavuz Savaþ Koca¹, Ömer Rýdvan Tarhan¹, Selçuk Kaya², Berit Gökçe Ceylan^3
1Süleyman Demirel Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Isparta, Türkiye
²Süleyman Demirel Üniversitesi Týp Fakültesi, Týbbi Mikrobiyoloji Anabilim Dalý, Isparta, Türkiye
³Süleyman Demirel Üniversitesi Týp Fakültesi, Anesteziyoloji Ve Reanimasyon Anabilim Dalý, Isparta, Türkiye

Amaç
Oda sýcaklýðýndaki serum fizyolojikle yapýlan periton lavajý peritonda hipotermi, vazokonstriksiyon, hipoksi ve asidoza neden olur. Bu etkilerin fibrinolizi azalttýðý bilinmektedir. Fibrinolizin bozulmasý ise kalýcý adezyona neden olmaktadýr. Normotermik lavaj bu zararlý süreci engelleyerek peritoneal adezyonlarý azaltabilir.

Gereç ve Yöntem
Rat çekal abrzyon modeli kullanýldý. Kontrol hayvanlarýna herhangi bir tedavi uygulanmazken, deney gruplarýna (her birinde n=24) hipotermik ve normotermik serum fizyolojik ile lavaj uygulandý. Postoperatif 1, 3 ve 10’uncu günlerde periton dokusunda peritoneal fibrinolizin ana parametreleri olan doku plazminojen aktivatörü (tPA) ve plazminojen aktivatör inhibitor tip-1 (PAI-1) bakýldý.
Adezyonlar ameliyat sonrasý 10. günde deðerlendirildi. Sham grubunda (n=8) laparotomi sonrasý periton örnekleri alýndý ve saðlýklý peritondaki bazal tPA ve PAI-1 deðerleri tespit edildi.

Bulgular
Çekal abrazyon, PAI-1 düzeylerini postoperif 1. günde yaklaþýk 10 kat kadar artýrarak adezyonlara neden oldu. Normotermik serum fizyolojik ile lavaj bu travmatik PAI-1 artýþýný engelleyerek deney boyunca normal seviyeye sabitledi ve adezyon geliþimini azalttý. Hipotermik lavaj da PAI-1 yükseliþini azalttý ancak adezyonlarýn önlenmesi istatistiksel olarak anlamlý deðildi.

Sonuç
Sonuçlarýmýz göstermektedir ki, normotermik serum fizyolojik ile lavaj peritoneal fibrinolizi düzelterek adezyonlarý azaltmaktadýr.

Anahtar Kelimeler: Normothermic, Hypothermic, Peritoneal Lavage, Peritoneal Adhesion, Saline Solution, Tissue Plasminogen Activator, Plasminogen Activator Inhibitor 1

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