The impact of gas laparoscopy on abdominal plasminogen activator activity

Background: The impairment of intestinal perfusion following induction of a pneumoperitoneum may lead to a reduction of peritoneal tissue plasminogen activator (tPA) activity and a concomitant increased risk of adhesion forma tion. Methods: Pigs were laparotomized to take peritoneal biopsy specimens from t he cecum. the ileum, and the abdominal wall. A 15 mmHg pneumoperitoneum was established for 3 h by the insufflation of carbon dioxide (group 2, n = 6) or helium (group 3, n = 6). Group 1 (n = 7) received no gas insufflation. After a 2-h recovery period, additional tissue samples were harvested. Spec ific tPA activity was then determined in the tissue extracts. Results: During surgery, specific tPA activity decreased in all the samples . As compared with the control group (100%), this reduction was strongly ag gravated in the cecum (-67.61%, p < 0.05) and the ileum (-70.8%) of the CO2 group but only slightly aggravated in the helium group. The parietal perit oneum was not specifically affected by gas insufflation. Conclusion: The use of a pneumoperitoneum with carbon dioxide significantly affects peritoneal tPA activity and thus may represent a stimulus for adhe sion formation.