HIGH LEVEL OF GLYCOSAMINOGLYCANS OF BLOOD SERUM AS AN INDEPENDENT PREDICTOR OF THE DEVELOPING PERITONEUM ADHESIVE DISEASE

Peritoneal commissures is the phenomenon of adhesions formation with apparent symptom group of violations in functioning of the gastrointestinal tract and small pelvis. Unlike other postoperative complications adhesive disease is characterized by high risk for life manifestations in the form of intestinal obstruction, infertility and chronic pain. It is known that in the process of restoring the integrity of the peritoneum the decisive role is given to makrophages, peritoneal immune system, processes of angiogenesis, increasing fibroblasts and collagen production. However, the biochemical processes taking place in the intercellular matrix of connective tissue, particularly, the exchange of glycosaminoglycans in the formation of peritoneal adhesions have not been studied. In this context, the main objective of this work was to study levels of glycosaminoglycans of the blood in the development of adhesive disease and justification of the use of indicators to exchange connective tissue as additional prognostic criteria for the development of postoperative adhesions. An open prospective randomized trial analyzed the data of 67 patients that were admitted for the planned reconstructive surgery on the anterior abdominal wall to eliminate postoperative ventral hernia, at the surgery department of State Clinical Hospital No. 8, city ofUFAduring the period of 2005-2008. The severity of adhesions was assessed and contrasted to the results of determination of glycosaminoglycans in blood serum. The total content of glycosaminoglycans, hyaluronic acid, chondroitin sulfates and heparan sulfates was determined. Postoperative monitoring stages of the studied indicators -3, 5 and 7 day after herniotomy. The group of patients with adhesive peritoneum desease showed total content of glycosaminoglycans by 19.2% (p < 0.0001) higher than reference values. It should be noted that there was continuous growth of all factions of glycosaminoglycans during all seven days of the postoperative monitoring. The growth of the overall content of the glycosaminoglycans made 261% (p < 0.0001) compared with the control group. Method of ROC-analysis established that the area under the ROC curve is a common glycosaminoglycans is equal 0.824 ± 0.055, 95% confidence interval-0.906 0.711. Sensitivity-70.4% (54.8 -86.0), specificity is 97.5% (82.4 -98.6). The optimum point for the division amounted to 30 μmol/l. Positive predicting level amounted to 96.8%, negative 75.1%. Thus, the assessment of the level of glycosaminoglycans can serve as an additional prognostic test to diagnose disturbance in intercellular matrix that can be used in the diagnosis of commissural process and in monitoring the effectiveness of preventive measures. 

1. Ten Broek RP, Bakkum EA, Laarhoven CJ, van Goor H. Epidemiology and prevention of postsurgical adhesions revisited. Ann Surg. 2016;263(1):12-9. DOI: 10.1097/SLA.0000000000001286.

2. Ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588. DOI: 10.1136/bmj.f5588.

3. Montz FJ, Holschneider CH, Solh S, Schuricht LC, Monk BJ. Small bowel obstruction following radical hysterectomy: risk factors, incidence, and operative findings. Gynecol Oncol. 1994;53:114-20. DOI: 10.1006/gyno.1994.1097.

4. Lower AM, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD, Crowe AM. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24046 patients. Hum Reprod. 2004;19:1877-85. DOI: 10.1093/humrep/deh321.

5. Parikh JA, Ko CY, Maggard MA, Zingmond DS. What is the rate of small bowel obstruction after colectomy? Am Surg. 2008;74:1001-1005. PMID: 18942632.

6. Foster NM, McGory ML, Zingmond DS, Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006;203:170-76. DOI: 10.1016/j.jamcollsurg.2006.04.020.

7. Kaminski P, Gajewska M, Wielgos M, Szymusik I, Ziolkowska K, Bartkowiak R. The usefulness of laparoscopy and hysteroscopy in the diagnostics and treatment of infertility. Neuro Endocrinol Lett. 2006;27:813-817. PMID: 17187014.

8. Milingos S, Kallipolitis G, Loutradis D, Liapi A, Mavrommatis K, Drakakis P, Tourikis J, Creatsas G, Michalas S. Adhesions: laparoscopic surgery versus laparotomy. Ann N Y Acad Sci. 2000;900:272–285. PMID: 10818415.

9. Johnson P, Richard C, Ravid A, Spencer L, Pinto E, Hanna M, Cohen Z, McLeod R. Female infertility after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum. 2004;47:111926. DOI: 10.1007/s10350-004-0570-7.

10. Ording Olsen K, Juul S, Berndtsson I, Oresland T, Laurberg S. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology. 2002;122:15-19. PMID: 11781275.

11. Demco L. Pain mapping of adhesions. J Am Assoc Gynecol Laparosc. 2004;11:181-83. PMID 15200771.

12. Wiseman DM. Disorders of adhesions or adhesion-related disorder: monolithic entities or part of something bigger CAPPS? Semin Reprod Med. 2008;26:356-68. DOI 10.1055/s-0028-1082394.

13. Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87:467-71. DOI: 10.1046/j.1365-2168.2000.01394.x.

14. Ten Broek RP, Strik C, Issa Y, Bleichrodt RP, van Goor H. Adhesiolysis-related morbidity in abdominal surgery. Ann Surg. 2013;258:98-106. DOI: 10.1097/SLA.0b013e31826f4969.

15. Ahmad G, Duffy JM, Farquhar C, Vail A, Vandekerckhove P, Watson A, Wiseman D. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2008;2:CD000475. DOI: 10.1002/14651858.CD000475.pub3.

16. Ahmad G, Mackie FL, Iles DA, O’Flynn H, Dias S, Metwally M, Watson A. Fluid and pharmacological agents for adhesion prevention after gynecological surgery. Cochrane Database Syst Rev. 2006;2:CD001298. DOI: 10.1002/14651858.CD001298.pub4.

17. Kumar S, Wong PF, Leaper DJ. Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after nongynaecological abdominal surgery. Cochrane Database Syst Rev. 2009;1:CD005080. DOI: 10.1002/14651858.CD005080.pub2.

18. Montz FJ, Shimanuki T, diZerega GS. Postsurgical mesothelial remesothelialization. In: de Cherney AH, Polan ML (editors). Reproductive surgery: Chicago, IL: Year Book, Medical Publishers; 1986:31-47. 19. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Dig Surg. 2001;18:260-73. DOI: 50149.

19. Damodarasamy M, Vernon RB, Chan CK, Plymate SR, Wight TN, Reed MJ. Hyaluronan in aged collagen matrix increases prostate epithelial cell proliferation. In Vitro Cell Dev Biol Animal. 2015;51(1):50-58. DOI:10.1007/s11626-014-9800-z.