Sublay repair results in superior mesh incorporation and histological fibrogenesis in comparison to onlay and primary suture in an experimental rat model
To compare adhesion scores, repair strength and histological findings among sublay, onlay and primary repair incisional hernioplasty techniques. Surgical repairs were employed directly on healthy animals, without previous hernia induction, to avoid confounding factors related to hernia development.
Forty Wistar rats were divided into four groups, control, simulation, onlay and sublay. After 42 days, adhesion intensity, tensile strength of the abdominal wall and anatomopathological histological substrate were compared.
SL group presented greater adhesion scores (p < 0.0001), higher tensiometric (p < 0.0001), and was characterized by more histiocytes, mononuclear cells, macrovacuolar granulomas and type I collagen on histological analysis. Pearson correlation between adhesions and tensiometry, and between tensiometry and neocollagenization showed a strong positive association (r = 0.8905 and 0.6757, respectively in SL group, p < 0.05).
Mesh positioning in sublay compartment was followed by increased adhesion development and provides a stronger mesh–tissue attachment, in addition, resulted in a different histological profile of the inflammation/repair substrate. The intensity of these findings was directly correlated, suggesting they could be the result of a common biological phenomenon. Our findings indicate that mesh placement following the retromuscular technique generates a superior repair response, and give clues to a better understanding of the superiority of sublay repair in achieving lower recurrence rates. Characterization of the cellular and molecular elements responsible for the superiority of this technique is in our view an essential prerequisite aiming for improvements in the therapeutic options for the treatment of this disease.
KeywordsIncisional hernia Sublay Adhesions Tensiometry Collagen
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest in this research.
The authors declare that that the ethical standards were obeyed, beginning their work and research after approval of the Ethics Committee for the Use of Animals in Scientific Experimentation of the Health Sciences Center of the Universidade Federal do Rio de Janeiro (CEUA-CCS), registered in the National Council for the Control of Animal Experimentation (CONCEA) under process number 01200.001568/2013-87.
Human and animal rights
All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.
For this type of study, formal consent is not required.
- 2.den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438Google Scholar
- 5.Biondo-Simões MLP, Morais CF, Tocchio AFZ, Miranda RA, Moura PAP, Colla K, Robes RR, Ioshii SO, Tomasich FDS (2016) Characteristics of the fibroplasia and collagen expression in the abdominal wall after implant of the polypropylene mesh and polypropylene/polyglecaprone mesh in rats. Acta Cir Bras 31:294–299CrossRefGoogle Scholar
- 6.Nursal TZ, Hamalogku E (1999) Insizyonel herniler. T Klin Cerrahi 4:182–187Google Scholar
- 12.Rivers J, Lardennois B, Pire JC, Hibon J (1973) Large incisional hernias. The importance of flail abdomen and of subsequent respiratory disorders. Chirurgie 99(8):547–563Google Scholar
- 13.Neligan P, Peter C (2015) Plastic surgery: principles, 3rd edn. Elsevier, Rio de Janeiro, pp 240–252Google Scholar
- 15.Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW et al (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 390(10094):567–576CrossRefGoogle Scholar