Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 6, November-December, p. 1193–1198

doi: 10.17219/acem/44381

Publication type: original article

Language: English

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The Impact of 0.9% NaCl on Mesothelial Cells After Intraperitoneal Lavage During Surgical Procedures

Jarosław Cwaliński1,2,3,A,B,C,D, Andrzej Bręborowicz4,A,E,F, Alicja Połubińska4,B,C

1 Department of Pathophysiology, Poznan University of Medical Sciences, Poland

2 Heliodor Swiecicki Clinic Hospital, Poznan University of Medical Sciences, Poland

3 Department of General, Gastroenterological and Endocrine Surgery, Poznan University of Medical Sciences, Poland


Background. Normal saline gained wide popularity in abdominal surgery as a basic compound used in intraoperative drainage of the peritoneal cavity. However, recent studies have revealed that saline solution is not quite biocompatible with the intraperitoneal enviroment and may promote peritoneal adhesions.
Objectives. The aim of the study was to evaluate the function and viability of human mesothelial cells cultured in vitro in 0.9% NaCl solution from intraperitoneal lavage carried out during laparoscopic cholecytectomies.
Material and Methods. The study included 40 consecutive patients suffering from gallstones who underwent laparoscopic cholecystectomy. Fluid was collected after intraperitoneal lavage during the surgical procedures. The samples obtained were used as a medium for in vitro incubation of primary human mesothelial cells. After 24 h the synthesis of interleukin 6 (IL-6), plasminogen activator inhibitor (PAI) and tissue plasminogen activator (tPA), as well as the index of cell proliferation were assessed in all the experimental groups.
Results. All the mesothelium cell cultures treated with fluid samples obtained ex vivo were characterized by elevated levels of IL-6. The highest concentrations of PAI-1 were found in groups of cells exposed to fluid with bile; similarly, tPA synthesis was extremely elevated in groups treaded with fluid containing bile and small amounts of hemolyzed blood. In contrast, cell proliferation was exceedingly high in 2 groups of cells placed in a standard culture medium and in 0.9% NaCl solution.
Conclusion. Normal saline introduced into the abdominal cavity modifies the biological and physicochemical conditions of the intraperitoneal environment. The impact of 0.9% NaCl on mesothelial cells is manifested in destabilized tissue regeneration, which supposedly initiates adhesion formation.

Key words

oxidative stress, peritoneal adhesions, intraperitoneal lavage, tPA/PAI-1 ratio, fibrinolytic disability

References (30)

  1. Arung W, Meurisse M, Detry O: Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol 2011, 17, 4545−4553.
  2. Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, Bakkum EA, Rovers MM, van Goor H: Burden of adhesions in abdominal and pelvic surgery: Systematic review and meta-analysis. BMJ 2013, 347, 5588.
  3. Ellozy SH, Harris MT, Bauer JJ, Gorfine SR, Kreel I: Early postoperative small-bowel obstruction: A prospective evaluation in 242 consecutive abdominal operations. Dis Colon Rectum 2002, 45, 1214−1217.
  4. Ten Broek RP, Kok-Krant N, Bakkum EA, Bleichrodt RP, van Goor H: Different surgical techniques to reduce post-operative adhesion formation: A systematic review and meta-analysis. Hum Reprod Update 2013, 19, 12−25.
  5. Holmdahl L: The role of fibrinolysis in adhesion formation. Eur J Surg Suppl 1997, 577, 24−31.
  6. Suzuki T, Kono T, Bochimoto H, Hira Y, Watanabe T, Furukawa H: An injured tissue affects the opposite intact peritoneum during postoperative adhesion formation. Sci Rep 2015, 5, 7668.
  7. DiZerega GS: Biochemical events in peritoneal tissue repair. Eur J Surg 1997, 577, 10−16.
  8. Grocott M, Hamilton M: Resuscitation fluids. Vox Sang 2002, 1, 1−8.
  9. Roberts LM, Sanfilippo JS, Raab S: Effects of laparoscopic lavage on adhesion formation and peritoneum in an animal model of pelvic inflammatory disease. J Am Assoc Gynecol Laparosc 2002, 9, 503−507.
  10. Van Westreenen M1, van den Tol PM, Pronk A, Marquet RL, Jeekel J, Leguit P: Perioperative lavage promotes intraperitoneal adhesion in the rat. Eur Surg Res 1999, 31, 196−201.
  11. Veech RL: The toxic impact of parenteral solutions on the metabolism of cells: A hypothesis for physiological parenteral therapy. Am J Clin Nutr 1986, 44, 519−551.
  12. Połubińska A, Winckiewicz M, Staniszewski R, Breborowicz A, Oreopoulos DG: Time to reconsider saline as the ideal rinsing solution during abdominal surgery. Am J Surg 2006, 192, 281−285.
  13. Kappas AM, Fatouros M, Papadimitriou K, Katsouyannopoulos V, Cassioumis D: Effect of intraperitoneal saline irrigation at different temperatures on adhesion formation. Br J Surg 1988, 75, 854−856.
  14. Bręborowicz A, Rodela H, Oreopoulos DG: Toxicity of osmotic solutes on human mesothelial cells in vitro. Kidney Int 1992, 41, 1280−1285.
  15. Połubinska A, Breborowicz A, Staniszewski R, Oreopoulos DG: Normal saline induces oxidative stress in peritoneal mesothelial cells. J Pediatr Surg 2008, 43, 1821−1826.
  16. Bręborowicz A, Oreopoulos DG: Is normal saline harmful to the peritoneum? Perit Dial Int 2005, Suppl 4, 67−70.
  17. Brokelman W, Holmdahl L, Falk P, Klinkenbijl J, Reijnen M: The peritoneal fibrinolytic response to conventional and laparoscopic colonic surgery. J Laparoendosc Adv Surg Tech A 2009, 19, 489−493.
  18. Holmdahl L, Eriksson E, al-Jabreen M, Risberg B: Fibrinolysis in human peritoneum during surgery. Surgery 1996, 119, 701−705.
  19. Hellebrekers BW, Kooistra T: Pathogenesis of postoperative adhesion formation. Br J Surg 2011, 98, 1503−1516.
  20. Ljubuncic P, Fuhrman B, Oiknine J, Aviram M, Bomzon A: Effect of deoxycholic acid and ursodeoxycholic acid on lipid peroxidation in cultured macrophages. Gut 1996, 39, 475−478.
  21. Brokelman WJ, Lensvelt M, Borel Rinkes IH, Klinkenbijl JH, Reijnen MM: Peritoneal changes due to laparoscopic surgery. Surg Endosc 2011, 1, 1−9.
  22. Bergström M, Falk P, Holmdahl L: CO2 promotes plasminogen activator inhibitor type l expression in human mesothelial cells. Surg Endosc 2003, 11, 1818−1822. Epub 2003 Jun 17.
  23. Ziprin P, Ridgway PF, Peck DH, Darzi AW: Laparoscopic-type environment enhances mesothelial cell fibrinolytic activity in vitro via a down-regulation of plasminogen activator inhibitor-l activity. Surgery 2003, 134, 758−765.
  24. Saksela O, Hovi T, Vaveri Z: Urokinase-type plasminogen activator and its inhibitor are secreted by cultured human monocytes-macrophages. Am J Pathol 1994, 144, 1269–1280.
  25. Plow EF: Leukocyte elastase release during blood coagulation. A potential mechanism for activation of the alternative fibrinolytic pathway. J Clin Invest 1982, 3, 564−572.
  26. Hermanowicz A, Debek W, Oksiuta M, Matuszczak E, Dzienis-Koronkiewicz E, Chyczewski L: Peritoneal cell response during adhesion formation. J Invest Surg 2010, 23, 267−272.
  27. Graça-Souza AV, Arruda MA, de Freitas MS, Barja-Fidalgo C, Oliveira PL: Neutrophil activation by heme: Implications for inflammatory processes. Blood 2002, 11, 4160−4165.
  28. Fabiano G, Pezzolla A, Maiorino R, Ferrarese F: Peritoneal adhesions: Pathophysiology. G Chir 2008, 29, 115−125.
  29. Breborowicz A, Witowski J, Wieczorowska K, Martis L, Serkes KD, Oreopoulos DG: Toxicity of free radicals to mesothelial cells and peritoneal membrane. Nephron 1993, 65, 62−66.
  30. Książek K, Piątek K, Witowski J: Impaired response to oxidative stress in senescent cells may lead to accumulation of DNA damage in mesothelial cells from aged donors. Biochem Biophys Res Commun 2008, 373, 335−339.