Histology of the internal inguinal ring in patients with indirect inguinal hernia
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Abstract
Aim
The purpose was to investigate the basic histological structure of the internal inguinal ring in patients operated on for primary indirect inguinal hernia.
Patients and Methods
The study involved a sample of 72 consecutive male patients over 15 years of age, submitted to elective surgery for unilateral primary inguinal hernia. The primary outcome measures were the histological findings of the internal inguinal ring. Patients were divided into three groups according to age: group 1 included patients between 15 and 40 years of age, group 2 patients between 41 and 70 years of age, and group 3 patients older than 71 years of age.
Results
All samples from the internal inguinal ring comprised fibrous fascial tissue with elastic fibres which were thicker in groups 1 and 2, and thinner in group 3 (p<0.0001). Adipose tissue between elastic fibres was absent in group 1 (p=0.003), and was present in group 3 (p=0.001). Vascular sclerosis was minimum in group 1, moderate in group 2, and important in group 3 (p<0.0001). Acute or chronic inflammatory cells were absent in all patients. These changes were more significant with age, according to the analysis with multiple linear regression.
Conclusions
The basic histological characteristics of the internal inguinal ring in patients with indirect inguinal hernia consisted of reduced density and thickness of elastic fibres, and increased adipose tissue between elastic fibres, changes which became more significant with increasing age. Vascular sclerosis was also more severe in older patients compared to younger patients. These histological changes all appeared to be related to ageing.
Key words
Inguinal hernia indirect hernia internal inguinal ring hernia histologyPreview
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