Muscle degeneration in inguinal hernia specimens.
BACKGROUND
There are few articles in the literature reporting the histological changes of groin structures affected by inguinal hernia. A deeper knowledge of this matter could represent an important step forward in the identification of the causes of hernia protrusion. This study aimed to recognise the pathological modifications of muscular structures in autopsy specimens excised from tissues surrounding the hernia orifice.


METHODS
Inguinal hernia was identified in 30 autopsied cadavers, which presented different varieties of hernia, including indirect, direct and mixed. Tissue specimens were resected for histological study from structures of the inguinal area surrounding the hernia opening, following a standardised procedure. The histological examination was focussed on the detection of structural changes in the muscle tissues. The results were compared with biopsy specimens resected from corresponding sites of the inguinal region in a control group of 15 fresh cadavers without hernia.


RESULTS
Significant modification of the muscular arrangement of the inguinal area was recognized. Pathological alterations such as atrophy, hyaline and fibrotic degeneration, as well as fatty dystrophy of the myocytes were detected. These findings were observed consistently in the context of multistructural damage also involving vessels and nerves. In cadavers with hernia these alterations were always present independent of hernia type. No comparable damage was found in control cadavers without hernia.


CONCLUSIONS
The high degree of degenerative changes in the muscle fibres in the inguinal area involved in hernia protrusion described in this report seems to be consistent with chronic compressive damage. These alterations could embody one important factor among the multifactorial sources of hernia genesis. Conjectures concerning its impact on the physiology and biodynamics of the inguinal region are made. The relationship between the depicted degenerative injuries and the genesis of inguinal hernia is also a focus of  discussion in this article.
Department of General Surgery, Urgency, and Organ Transplantation, University of Palermo, via del Vespro 129, 90100, Palermo, Italy. amatomed@gmail.com
G
G
Amato
A
A
Agrusa
G
G
Romano
G
G
Salamone
G
G
Gulotta
F
F
Silvestri
R
R
Bussani
D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000473:pathology; D001284:Atrophy / Q000473:pathology; D001369:Axons / Q000473:pathology; D005355:Fibrosis / Q000473:pathology; D006119:Groin / Q000098:blood supply / Q000294:innervation / Q000473:pathology*; D006552:Hernia, Inguinal / Q000473:pathology*; D006801:Humans; D006818:Hyalin / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000378:metabolism / Q000473:pathology*; D014680:Veins / Q000473:pathology