title: Histological findings in direct inguinal hernia : investigating the histological changes of the herniated groin looking forward to ascertain the pathogenesis of hernia disease.
abstract: BACKGROUND
  The study is focused on recognizing the histological changes of the structures close to and around the hernia opening in patients having direct inguinal hernia.
  
  
  METHODS
  In 15 patients with primary bilateral direct inguinal hernia who underwent a Stoppa open posterior inguinal hernia repair, tissue specimens from the abdominal wall surrounding a direct hernia border were excised for histological examination. These findings in patients with direct inguinal hernia were compared with tissue specimens excised from the fossa inguinalis media of cadavers without hernia.
  
  
  RESULTS
  Significant degenerative modifications such as fibrohyaline degeneration and fatty substitution of the muscle fibers were seen in the biopsy samples. Inflammatory infiltration with lympho-histiocitary elements, artery sub-occlusion and vascular congestion were also constantly identified. Noteworthy injuries of the nervous structures such as edema, degenerative fibrosis and atrophy were also detected. No comparable tissue damage was witnessed in the control samples.
  
  
  CONCLUSIONS
  Presence of inflammatory infiltration, vascular damage and regressive nerve lesions, as well as fibrohyaline degeneration and fatty dystrophy of the muscle fibers are the features seen within the examined structures surrounding the direct hernia opening. These findings could represent a reason for a structural and functional weakening of the inguinal region. Consequently, the described results lead the authors to depict these changes as a plausible cause of direct inguinal hernia protrusion.
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via Rapisardi 66, 90144, Palermo, Italy, amatomed@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Amato
authors.forename: A
authors.initials: A
authors.lastname: Agrusa
authors.forename: G
authors.initials: G
authors.lastname: Romano
authors.forename: G
authors.initials: G
authors.lastname: Salamone
authors.forename: G
authors.initials: G
authors.lastname: Cocorullo
authors.forename: S A
authors.initials: SA
authors.lastname: Mularo
authors.forename: S
authors.initials: S
authors.lastname: Marasa
authors.forename: G
authors.initials: G
authors.lastname: Gulotta
mesh_terms: D034861:Abdominal Wall / Q000473:pathology*; D000328:Adult; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D016022:Case-Control Studies; D005355:Fibrosis; D006552:Hernia, Inguinal / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009410:Nerve Degeneration