Immunohistochemical evaluation of fibrillar components of the extracellular matrix of transversalis fascia and anterior abdominal rectus sheath in men with inguinal hernia.

Rogério De Oliveira Gonçalves,Gaspar De Jesus Lopes Filho,Evandro De Moraes E Silva

doi:10.1590/s0100-69912014000100006

Abstract

to evaluate the role of fibrillar extracellular matrix components in the pathogenesis of inguinal hernias. samples of the transverse fascia and of the anterior sheath of the rectus abdominis muscle were collected from 40 men aged between 20 and 60 years with type II and IIIA Nyhus inguinal hernia and from 10 fresh male cadavers (controls) without hernia in the same age range. The staining technique was immunohistochemistry for collagen I, collagen III and elastic fibers; quantification of fibrillar components was performed with an image analysis processing software. no statistically significant differences were found in the amount of elastic fibers, collagen I and collagen III, and the ratio of collagen I / III among patients with inguinal hernia when compared with subjects without hernia. the amount of fibrillar extracellular matrix components did not change in patients with and without inguinal hernia.

Highlights

The incidence and prevalence of abdominal wall hernias remain essentially unknown, and from the operations for correction of abdominal wall hernias, inguinal hernia repair is the most commonly performed by the general surgeon[1].It has been decades since the research directed at investigation of the factors involved in the weakness of the posterior wall of the inguinal canal began, in an attempt to answer the fundamental question involved in the pathogenesis of inguinal hernias, ie, if these are consequences of an excessive mechanical stress or local manifestation of a metabolic disturbance of extracellular matrix components[2,3,4,5,6]
All these works attributed to components of the extracellular matrix the property of conferring strength and integrity to the aponeuroses and fascias, these structures being considered by some authors[7,8] as fundamental for the anatomical integrity of the posterior wall of the inguinal canal
It is an opening in the lower abdominal wall closed just by the transversalis fascia, whose resistance is conferred by collagen and elastic fibers – the two main extracellular matrix fibrillar components[9]

Summary

Introduction

The incidence and prevalence of abdominal wall hernias remain essentially unknown, and from the operations for correction of abdominal wall hernias, inguinal hernia repair is the most commonly performed by the general surgeon[1] It has been decades since the research directed at investigation of the factors involved in the weakness of the posterior wall of the inguinal canal began, in an attempt to answer the fundamental question involved in the pathogenesis of inguinal hernias, ie, if these are consequences of an excessive mechanical stress or local manifestation of a metabolic disturbance of extracellular matrix components[2,3,4,5,6]. This raises the question whether the use of synthetic prostheses is a procedure that eliminates tension – considered the main element involved in recurrence – or indirectly addresses the metabolic changes present in the pathogenesis of inguinal hernias

Objectives

Methods

Results