Tracking stem cells in the incisional hernial sac: a gaze beyond pure tissue repairs

Abstract

Objective: the hernial sac is typically a bilayer structure consisting of connective tissue lined underneath by peritoneum. Some incidental findings on it, like smooth muscle cells and heterotopic ossification, can be explained as the end-stage metaplasia from undifferentiated cells. This study aimed to search for mesenchymal stem cells in the incisional hernial sac by an immuno-histochemistry screening test. Methods: fifteen specimens of them were submitted to histochemistry analysis using CD133 monoclonal antibodies, a specific marker of mesenchymal stem cells. The biopsies were obtained from patients submitted to pure tissue repair for incisional hernias - the transposition with the hernial sac technique (Lázaro da Silva, 1971). Results: two-thirds of the specimens expressed on average 20 (twenty) CD133+ cells in each one. Conclusion: despite the screening nature of this study, the hernial sac may be considered a source of stem cells. This could explain those abnormal findings, and perhaps the induction of new fibroblasts in procedures that use it to optimize wound healing.

Endoscopic transposition with the hernial sac (eTHS) in ventral hernia repair - technical description

“…The tempting possibility of using the hernial sac as part of the incisional hernia repairs, associated with the relaxing of the incisions without damaging the abdominal wall was defended by Lázaro da Silva, more than 50 years ago [10][11][12]27 . Soft muscle fibers, vascular neoformation and heterotopic tissues were described as an autologous graft in the peritoneal hernial sac 28,30 . The primary fascial repairs let to unacceptable recurrence rates as high as 46% 6 .…”