Determination of Hyaluronic Acid and N-Peptide of Collagen Type Iii Levels in Serum as Predictors of the Peritoneal Adhesions Development in Children

Abstract

Introduction. Adhesive peritoneal disease (APD) is the most common and formidable complication of abdominalsurgery, which led to adhesive processing occurring in 70 to 90 % of operated patients. It is manifested by lateadhesion intestinal obstruction (LAIO), chronic abdominal pain, constipation and infertility.The aim of the study was to investigate the levels of hyaluronic acid (HA) and N-peptide collagen type III (N-PCIII) in serum to determine the course of APD in children.Material and methods. Serum levels of HA and N-PC type III were determined in 148 children aged 6-17 years (83boys and 65 girls). I group (main) – 38 patients with APD, LAIO treatment with the use solution of natrii hyaluronasand decamethoxine, II comparison group – 35 children with APD, LAIO treatment by traditional methods, III group – 45patients operated on for other acute surgical pathologies of GI tract in which after surgery for 5-10 years no signsof APD were noted. The control group consisted of 30 children operated on inguinal hernias.All parents were given informed voluntary written consent to conduct the research. Statistical processing of theobtained results was performed using Microsoft Office Excel and Statistica 10.0 (StatSoft Inc.).Results. An increase in HA level in the control, main and comparative groups on the 5th day of postoperative periodwas registered by 31,94, 126,96 and 39,60%, respectively, in comparison with the preoperative values; on the 14th daydecrease in HA level was observed in all groups, by 21,24, 32,79 and 25,83%, respectively, in comparison with the 5th day.Determination of the level of N-PC type III in all groups showed an increase in its number on the 5th day,compared with pre-surgery by 64.62, 57.40 and 79.32 %, respectively. On the 14th day the level was 2 times higher inthe main group and 2.86 times higher in the comparison group, compared with the control indicators. This indicatedthe stabilization of connective tissue organization and peritoneal regeneration in the main group and the lack of clearperitoneal regeneration in the comparison group.Conclusions.1. Serum levels of HA and N-PC type III may be markers of the onset and development of APD in children.2. An increase in the level of HA by more than 30%, and N-PC type III by 90 %, compared with control indicators,a year or more after undergoing surgery for APD, LAIO, may indicate a high risk of recurrence and be used as anadditional prognostic indicator.3. Intraoperative use of sodium hyaluronate and decamethoxine in abdominal surgery and the use of localadhesiolysis as anti-adhesive measures help reduce the risk of re-adhesion in children.