[Origin of increased postoperative growth after laser surgical intervention in the peritoneal cavity--an experimental...

This work deals with the localization and chronology of the appearance of tissue-plasminogen-activator (t-pa) in coagulated and vaporized peritoneal lesions. 21 female WISTAR-rats were laparotomized, similar areas of the parietal peritoneum being vaporized and coagulated. The excision of these lesions was done at seven preset time intervals from 0 to 48 hours postoperatively. The occurrence of t-pa and fibrin was shown by immunohistochemical staining of cryo- and plastic-embedded sections. The differentiation of cells was done with immuno- and enzymhistochemical techniques. The inflammatory response of vaporized lesions shows to be more intense, i.e. exsudation of more fibrin, higher amount of inflammatory cells and a strongly emphasized tendency of adhesion-formation. There is a very low amount of t-pa-reactive cells up to 12 hours postoperatively, increasing after 24 and 48 hours but staying low in relationship to the total amount of cells. In coagulated lesions there is a steady increase of t-pa-reactive cells up to 12 hours postoperatively. Adjacent undamaged peritoneal areas in both types of lesions show a significant t-pa-reactivity. The visible reactivity to t-pa can be localized almost exclusively around monocytes and peritoneal macrophages. Both types of lesions do contain closely the same number of KiM2R-reactive mononuclear cells. There is an increased number of mastcells in vaporized lesions. There is more research needed to be done on the influence of different traumatic impacts on the peritoneum in order to find a causal approach to prevention of adhesions. Right now the only causal way to minimize the incidence of iatrogenic postoperative adhesions is the use of the Semm's well known Endo-coagulation-Technique.