, Volume 22, Issue 6, pp 1089–1100 | Cite as

Sublay repair results in superior mesh incorporation and histological fibrogenesis in comparison to onlay and primary suture in an experimental rat model

  • F. Ponce Leon
  • J. E. F. Manso
  • V. L. Abud
  • W. Nogueira
  • P. C. Silva
  • R. Martinez
Original Article



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.


Incisional 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.

Ethical approval

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.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Interdisciplinar Surgical Science Post-Graduate CourseUniversidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  2. 2.Department of SurgeryUniversidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  3. 3.Department of PathologyHospital da Força Aérea do Galeão (HFAG)Rio de JaneiroBrazil
  4. 4.Universidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  5. 5.Departamento de Pós Graduação em Ciências Cirúrgicas da Universidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  6. 6.Rio de JaneiroBrazil

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