Elsevier

Advances in Medical Sciences

Volume 63, Issue 2, September 2018, Pages 220-223
Advances in Medical Sciences

Original research article
TGF-β and inflammatory blood markers in prediction of intraperitoneal adhesions

https://doi.org/10.1016/j.advms.2017.11.006Get rights and content

Abstract

Purpose

Intraperitoneal adhesions (IA) develop as a consequence of the healing process in peritoneum injured during surgeries. IA might be formed after all types of surgical interventions regardless the surgical approach with a higher incidence in obese individuals. Here we determine the diagnostic power of TGF-β and blood inflammatory parameters in the prediction of IA in obese patients undergoing second surgical intervention.

Materials and methods

Eighty patients were divided into groups according to body mass index (BMI) values and presence of intraperitoneal adhesions (IA). Evaluation of peritoneal adhesion index (PAI), serum TGF-β and blood inflammatory parameters was performed.

Results

Level of TGF-β, C-reactive protein (CRP), leukocytes, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were significantly higher in obese patients while TGF-β, CRP, and leukocytes were higher in patients with IA. There was a significant correlation between PAI values and TGF-β concentration (p < 0.001; r = 0.869) in IA group.

Conclusions

The preoperative TGF-β concentration, BMI, CRP and NLR could be strong predictors of intraperitoneal adhesions in patients with the history of surgeries.

Introduction

Intraperitoneal adhesions (IA) develop as a consequence of the healing process in peritoneum injured during surgeries. IA might be formed after all types of surgical interventions regardless the surgical approach [1]. The presence of IA might lead to perioperative as well as postoperative complication including accidental abdominal viscera injuries, longer duration of surgery, chronic abdominopelvic pain, intestinal obstruction, and infertility [2], [3].

Peritoneum repair involves a various process e.g. inflammation, angiogenesis, cell migration and adhesion [4]. These interactions are controlled by cytokines and growth factors secreted by mesothelial cells and migrated macrophages [5]. Among many cytokines transforming growth factor-β (TGF-β) has been documented to be associated with IA development [6]. Increased secretion of TGF-β due to tissue injury alters the adhesive properties of cells, expression of integrins, cytoskeletal proteins and induces migration of fibroblasts [6], [7].

IA development could be altered by excessive mass of adipose tissue. Low-grade inflammation accompanies obesity. Increased level of numerous inflammatory chemicals including, e.g. C-reactive protein (CRP), interleukin-1 (IL-1), interleukin-6 (IL-1), tumor necrosis factor-α (TNF-α), TGF-β, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), might stimulate the formation IA [8], [9], [10].

The aim of the research is an evaluation of the inflammatory markers: TGF-β, WBC, CRP, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio between obese and non-obese patients with the history of abdominopelvic surgical intervention who underwent elective surgeries. Additionally, we aim to assess the diagnostic power of the preoperative value of TGF-β and selected inflammatory blood parameters in the prediction of intraperitoneal adhesions.

Section snippets

Materials and methods

The study enrolled eighty patients admitted to the General, Oncological and Minimally Invasive Surgery Department of the 1 st Military Clinical Hospital in Lublin, Poland for scheduled laparoscopic cholecystectomy, laparoscopic sleeve gastrectomy, transabdominal preperitoneal (TAPP) hernia repair or anterior abdominal wall hernia repair (IPOM). The same team of surgeons operated on all the patients. No complications were reported during the surgeries, and no malignancies were reported in the

Results

Forty obese and forty non-obese patients were enrolled in the study. The demographics, serum concentration of TGF-β, and laboratory blood parameters of two BMI groups are shown in Table 1. The age and gender distribution did not differ significantly between the studied groups.

The mean value of BMI, TGF-β, CPR, and WBC was significantly higher in obese patients compared to the non-obese group. Nevertheless, NLR and PLR were higher in obese than in the non-obese patients, the difference was not

Discussion

Numerous surgical procedures using minimally invasive techniques are performed each day. Therefore preoperative knowledge of IA presence would be essential and might limit the ratio of complication or procedure conversions from laparoscopic into open technique [12], [13], [14]. Although few studies have attempted to evaluate the occurrence of potential difficulties preoperatively using ultrasonography (US) still there is a need to discover biomarkers for predicting e.g. intraperitoneal

Conclusions

Our results showed that preoperative TGF-β concentration, BMI, CRP and NLR could be strong predictors of intraperitoneal adhesions in patients with the history of surgeries. Further studies should include larger population to confirm the importance and diagnostic value of blood parameters in the prediction of intraperitoneal adhesions occurrence.

Conflict of interest

The authors declare no conflict of interests.

Financial disclosure

This work was supported by the grant of Medical University of Lublin (grant # DS205).

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