Histological findings in direct inguinal hernia

Amato, Giuseppe; Agrusa, Antonino; Romano, G.; Salamone, Giuseppe; Cocorullo, Gianfranco; Mularo, S.; Marasà, S; Gulotta, Gaspare

doi:10.1007/s10029-012-1032-0

Cited by 29 publications

(12 citation statements)

References 16 publications

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“…Following the latest evidence in the pathophysiology of the herniated groin, a new line of thought has recently emerged. A series of scientific reports has revealed that degenerative injury affecting the herniated groin histologically assumes the typical aspect of chronic compressive damage . It is evident that no other source of chronic compression exists in this area except the steady impact of the abdominal viscera against the groin.…”

Section: Discussionmentioning

confidence: 99%

“…In literature, this feature is thought to be related to the static nature of the flat meshes which, incorporated by motionless and rigid tissue elements, impede the regular muscle function of the repaired groin . Furthermore, recent studies concerning the pathogenesis of hernia disease have demonstrated the degenerative source of inguinal protrusions . This has generated new interest in the search for a more physiological and pathogenetic consequent repair concept of inguinal hernias.…”

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confidence: 99%

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Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Amato

Puleio²,

Agrusa³

et al. 2018

Artificial Organs

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Despite undisputed improvements, prosthetics hernia repair continues to be affected by unacceptable rates of complications. Postoperative adverse events such as discomfort and chronic pain represent a subject of increasing concern among the surgical community. Poor quality biologic response, stiff scar plates, and mesh shrinkage, a typical effect of conventional static meshes and plugs, are all indicated as the main reasons for many of the complications related to inguinal hernia repair. Even the conventional concept of treatment based upon a supposed reinforcement of the groin consequent to the fibrotic incorporation of meshes, would appear to be inadequate in the light of the latest scientific evidence concerning the degenerative genesis of inguinal hernia. Following these recent studies, a newly conceived 3D dynamically responsive implant has been developed. It concerns a multilamellar shaped prosthesis, intended to be placed fixation‐free to obliterate the hernia defect. This 3D structure has already demonstrated to induce a probiotic biological response with development of viable tissue, instead of the fibrotic plaque typical of conventional meshes. Newly formed elastic fibers, neo‐angiogenesis, and neo‐nerve genesis in a surrounding of well perfused connective tissue are the typical elements of the biologic response in the newly conceived implant. In addition to these elements, muscle fibers have also been detected in the implant structure. The aim of this research was to determine the ingrowth of muscle fibers in the implant by assessing the quantity and quality of muscle development in the short, medium, and long term post‐implantation. Histological examination of biopsy samples excised from patients who underwent dynamic hernia repair with the 3D dynamic implant showed the presence of muscular elements that in the short term could be described as multiple spots of myocytes in the early stage of development. Over the mid‐ to long‐term, muscle fibers increased in number and level of maturation, assuming the typical aspect of standard muscle bundles in the final phase. Effectively, long term, myocytes histologically evidenced the distinctive arrangement of the muscle structure, with nuclei and striated elements being similar to normal muscle elements. The development of this highly specialized connective tissue in the 3D dynamic responsive implant seems to document the finalization of an enhanced biologic response leading to the ingrowth of typical tissue components of the groin. Reverting degenerative pathogenesis into effective regeneration recognized in the newly conceived 3D prosthesis would appear to represent a significant concept change in the repair of inguinal hernias.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Amato

Puleio²,

Agrusa³

et al. 2018

Artificial Organs

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“…Previous studies in mice suggest that the development of scrotal hernias may be associated with abnormalities in the abdominal muscles, particularly those in the inguinal region ( 9 , 10 ). In men, histological studies have identified myocyte (myofiber) atrophy, fibrosis, and fatty degeneration in the internal inguinal ring area from indirect hernia patients and in the abdominal wall surrounding a direct hernia border ( 11 – 13 ). LAM tissue is composed of layers of oblique and transverse skeletal muscle made of myocytes.…”

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confidence: 99%

Shift from androgen to estrogen action causes abdominal muscle fibrosis, atrophy, and inguinal hernia in a transgenic male mouse model

Zhao

Coon

et al. 2018

Proc. Natl. Acad. Sci. U.S.A.

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SignificanceInguinal hernia is one of the most common disorders that affect elderly men. A major pathology underlying inguinal hernia is the fibrosis and other degenerative changes that affect the lower abdominal muscle strength adjacent to the inguinal canal. Here we describe a critical role of estrogen and its nuclear receptor that enhance fibroblast proliferation and muscle atrophy, leading to inguinal hernia. Further research may reveal a potential role of estrogen ablation to prevent muscle fibrosis or hernia in a subset of elderly men.

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“…As the inguinal region is one of the most motile areas of the body, it is surprising that all prosthetics used for hernia repair are static devices. Recent evidence indicates that inguinal hernia is a degenerative disease . Therefore, to repair abdominal wall defects, the goal of the employed therapy should be to regenerate typical abdominal wall tissue components.…”

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confidence: 99%

Biologic Response of Inguinal Hernia Prosthetics: A Comparative Study of Conventional Static Meshes Versus 3D Dynamic Implants

et al. 2015

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Despite improvements in prosthetics and surgical techniques, the rate of complications following inguinal hernia repair remains high. Among these, discomfort and chronic pain have become a source of increasing concern among surgeons. Poor quality of tissue ingrowth, such as thin scar plates or shrinking scars-typical results with conventional static implants and plugs-may contribute to these adverse events. Recently, a new type of 3D dynamically responsive implant was introduced to the market. This device, designed to be placed fixation-free, seems to induce ingrowth of viable and structured tissue instead of regressive fibrotic scarring. To elucidate the differences in biologic response between the conventional static meshes and this 3D dynamically responsive implant, a histological comparison was planned. The aim of this study was to determine the quality of tissue incorporation in both types of implants excised after short, medium, and long periods post-implantation. The results showed large differences in the biologic responses between the two implant types. Histologically, the 3D dynamic implant showed development of tissue elements more similar to natural abdominal wall structures, such as the ingrowth of loose and well-hydrated connective tissue, well-formed vascular structures, elastic fibers, and mature nerves, with negligible or absent inflammatory response. All these characteristics were completely absent in the conventional static implants, where a persistent inflammatory reaction was associated with thin, hardened, and shrunken fibrotic scar formation. Consequently, as herniation is a degenerative process, the 3D dynamic implants, which induce regeneration of the typical groin components, seem to address its pathogenesis.

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Histological findings in direct inguinal hernia

Cited by 29 publications

References 16 publications

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Neomyogenesis in 3D Dynamic Responsive Prosthesis for Inguinal Hernia Repair

Shift from androgen to estrogen action causes abdominal muscle fibrosis, atrophy, and inguinal hernia in a transgenic male mouse model

Biologic Response of Inguinal Hernia Prosthetics: A Comparative Study of Conventional Static Meshes Versus 3D Dynamic Implants

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