A O Mosanya1,2, O Olasehinde3,4, O O Odujoko5,6, A C Etonyeaku3,4, C C Adumah7,8, E A Agbakwuru3,4. 1. Department of Surgery, Ben S. Carson Snr. School of Medicine, Babcock University Teaching Hospital, Babcock University, Ilishan-Remo, Ogun State, Nigeria. nzemos@gmail.com. 2. Department of Surgery, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria. nzemos@gmail.com. 3. Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria. 4. Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. 5. Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria. 6. Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. 7. Department of Surgery, Ben S. Carson Snr. School of Medicine, Babcock University Teaching Hospital, Babcock University, Ilishan-Remo, Ogun State, Nigeria. 8. Department of Surgery, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
Abstract
PURPOSE: Altered composition of collagen and elastin in abdominal fascia has been linked with the pathogenesis of hernias. This has not been studied amongst Africans who have hernia presentations which vary significantly from Caucasian cohorts. The aim of this study was to determine, and compare, the collagen and elastin contents of the transversalis fascia and rectus sheath of inguinal hernia patients with non-hernia controls. METHODS: Twenty-five patients with solitary, primary, uncomplicated inguinal hernia and twenty-five non-hernia controls were evaluated. Biopsies of the transversalis fascia and anterior rectus sheath were stained with Masson Trichrome and Verhöeff van-Gieson to isolate collagen and elastin respectively, which were quantified using the ImageJ/Fiji® image analysis software. RESULTS: Inguinal hernia patients were aged 19-85 years with a mean age of 45.2 years, mean body mass index (BMI) of 23.3 kg/m2 and mean duration of hernia of 42.5 months. Lateral hernias with no hernia defect or posterior wall defect [PL0] were the predominant clinical type. There were significantly lower collagen and higher elastin content in the transversalis fascia and rectus sheath of inguinal hernia patients [P < 0.001]. Regression analysis identified smoking and long duration of hernias as independent predictors of low collagen levels in this study CONCLUSION: Inguinal hernia patients in the study population demonstrated depleted collagen in the connective tissue of the inguinal canal. This might justify the routine use of prosthetic mesh for the reinforcement of the posterior wall during hernia repair.
PURPOSE: Altered composition of collagen and elastin in abdominal fascia has been linked with the pathogenesis of hernias. This has not been studied amongst Africans who have hernia presentations which vary significantly from Caucasian cohorts. The aim of this study was to determine, and compare, the collagen and elastin contents of the transversalis fascia and rectus sheath of inguinal herniapatients with non-hernia controls. METHODS: Twenty-five patients with solitary, primary, uncomplicated inguinal hernia and twenty-five non-hernia controls were evaluated. Biopsies of the transversalis fascia and anterior rectus sheath were stained with Masson Trichrome and Verhöeff van-Gieson to isolate collagen and elastin respectively, which were quantified using the ImageJ/Fiji® image analysis software. RESULTS:Inguinal herniapatients were aged 19-85 years with a mean age of 45.2 years, mean body mass index (BMI) of 23.3 kg/m2 and mean duration of hernia of 42.5 months. Lateral hernias with no hernia defect or posterior wall defect [PL0] were the predominant clinical type. There were significantly lower collagen and higher elastin content in the transversalis fascia and rectus sheath of inguinal herniapatients [P < 0.001]. Regression analysis identified smoking and long duration of hernias as independent predictors of low collagen levels in this study CONCLUSION:Inguinal herniapatients in the study population demonstrated depleted collagen in the connective tissue of the inguinal canal. This might justify the routine use of prosthetic mesh for the reinforcement of the posterior wall during hernia repair.
Entities:
Keywords:
Collagen; Elastin; Inguinal hernia; Rectus sheath; Transversalis fascia
Authors: E A Agbakwuru; O Olasehinde; C I Onyeze; A C Etonyeaku; A O Mosanya; F O Wuraola; A A Akinkuolie; A A Aderounmu; A O Adisa Journal: Hernia Date: 2019-05-25 Impact factor: 4.739