J Surg Res. 2013 May 1;181(1):25-31. doi: 10.1016/j.jss.2012.05.056. Epub 2012 Jun 6.

Substance P is an early mediator of peritoneal fibrinolytic pathway genes and promotes intra-abdominal adhesion formation.

Esposito AJ1, Heydrick SJ, Cassidy MR, Gallant J, Stucchi AF, Becker JM.

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Abstract

BACKGROUND:

The substance P (SP) or neurokinin-1 receptor pathway has been implicated in intra-abdominal adhesion formation, in large part through its effects on peritoneal fibrinolysis. This study investigates the role of SP as an early mediator of the messenger RNA (mRNA) expression of key components of the peritoneal fibrinolytic system and other fundamental adhesiogenic pathways.

MATERIALS AND METHODS:

Intra-abdominal adhesions were surgically induced in 28 rats using the ischemic button model. mRNA levels of tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), hypoxia-inducible factors (HIFs) 1α and 2α, and vascular endothelial growth factor A (VEGF-A) were measured in adhesive button tissue taken at time 0 and 1, 3, 6, 12, and 24h after surgery in rats receiving an intraoperative peritoneal bolus (25mg/kg) of a neurokinin-1 receptor antagonist (NK-1RA) or saline. Peritoneal fluid fibrinolytic activity was measured in peritoneal lavages taken at the same time points.

RESULTS:

SP levels increased (P≤0.05) within 1h postoperatively followed by an increase (P≤0.05) in tPA mRNA expression from 3 to 6h after surgery along with a striking increase (P≤0.05) in PAI-1 mRNA expression from 3 to 12h. NK-1RA administration further increased (P≤0.05) tPA mRNA expression and significantly blunted the increase in PAI-1 mRNA levels. The NK-1RA increased (P≤0.05) fitbrinolytic activity in peritoneal fluid at 3, 12, and 24h after surgery. HIF-1α and VEGF-A mRNA expressions increased from 3 to 12h (P≤0.05) and from 1 to 3h (P≤0.05) after surgery, respectively, whereas HIF-2α mRNA expression steadily decreased. NK-1RA delayed the rise in HIF-1α mRNA and ablated the changes in HIF-2α and VEGF-A mRNAs.

CONCLUSIONS:

SP is a pleiotropic early regulator of mRNA levels of key adhesiogenic mediators after surgery, suggesting that it may be a viable therapeutic target.

Copyright © 2013 Elsevier Inc. All rights reserved.

PMID:

 

22765994

 

[PubMed - indexed for MEDLINE]

Am Surg. 2014 Mar;80(3):261-9.

A Comparative Analysis between Laparoscopic and Open Adhesiolysis at a Tertiary Care Center.

Davies SW1, Gillen JR, Guidry CA, Newhook TE, Pope NH, Hranjec T, Sawyer RG, Hallowell PT.

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Abstract

Laparotomy has been the favored approach regarding surgical management of small bowel obstruction (SBO); however, laparoscopy may offer improved outcomes. Patients undergoing laparoscopic lysis of adhesions (LOA) at our institution for SBO will have lower postoperative morbidity and 30-day mortality. Patients undergoing LOA at our institution, from 2000 to 2011, were reviewed. Categorical data were analyzed with χ(2) or Fisher's exact tests. Continuous data were analyzed with Student's t test or Wilcoxon rank sum. One hundred two (38 laparoscopic, 64 open) LOA cases were selected. Perioperative contamination and conservative management were higher in the open group. Open cases had a greater incidence of intensive care unit (ICU) admissions and longer length of stay. Stratified analysis determined a strong association between perioperative contamination and a higher incidence of ICU admission, perioperative contamination and longer LOS, and conservative management and longer LOS. Finally, patient outcome did not differ between those treated by surgeons trained in minimally invasive surgery (MIS) compared with those not trained in MIS. Careful consideration of surgical approach and timing is called for in all patients with SBO; however, whenever possible, laparoscopic preference should be given to most patients in an expeditious fashion irrespective of MIS training.

PMID:

 

24666867

 

[PubMed - in process]

Should You Get A J-Pouch?

Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis