Decreased Peritoneal Tissue Plasminogen Activator During Prolonged Laparoscopic Surgery

W. J A Brokelman*, Lena Holmdahl, I. M C Janssen, Peter Falk, Maria Bergström, J. H G Klinkenbijl, M. M P J Reijnen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

25 Citations (Scopus)


Background: Peritoneal fibrinolysis is crucial in the peritoneal healing processes and subsequent adhesion formation. During conventional surgery, the peritoneal fibrinolytic system is rapidly disturbed. Short-term laparoscopy does not seem to affect peritoneal fibrinolysis. The aim of the present study was to assess the effect of prolonged laparoscopic surgery on peritoneal fibrinolysis. Methods: Twelve consecutive patients undergoing laparoscopic gastric bypass surgery for morbid obesity were included in the study. During the procedure, biopsies of the parietal peritoneum were taken at the start of the procedure and each 45 min afterward. Tissue samples were homogenized and tissue-type plasminogen activator (tPA) antigen, tPA activity, urokinase-type PA antigen, and plasminogen activating inhibitors type 1 antigen were measured using commercial assay techniques. Results: Both tPA antigen and its activity progressively decreased during the procedure, reaching significant levels after 90 min of surgery. The levels of uPA antigen and plasminogen activating inhibitors antigen did not significantly change throughout the procedure. Conclusions: As for conventional surgery, prolonged laparoscopic surgery causes a decreased fibrinolytic activity in the peritoneum due to decreased tPA levels.

Original languageEnglish
Pages (from-to)89-93
Number of pages5
JournalJournal of Surgical Research
Issue number1
Publication statusPublished - 1 Jan 2009
Externally publishedYes


  • fibrinolysis
  • peritoneum
  • prolonged laparoscopy


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