Cirênio de Almeida Barbosa

Abdominal wall healing in incisional hernia using different biomaterials in rabbits

PURPOSE To investigate abdominal wound healing using specific biomaterials in incisional hernias. METHODS Incisional hernias were produced in 40 rabbits, after that they were reoperated with or without the use of meshes: PREMILENE® (PPL), ULTRAPRO® (UP), PROCEED® (PCD) or repairing without mesh (TRANSPALB). After 30 days a macroscopic and microscopic study of the part withdrawn from the abdominal wall was performed. RESULTS Macroscopic: adhesion Area: PPL> UP and PCD (p = 0.031). Vascularization: PPL> UP and PCD (p = 0.001). PPL groups (p = 0.032) and PCD (p <0.001) showed greater meshes shrinkages when compared to UP. Microscopic: neutrophils: PCD> PPL, UP and TRANSPALB (p = 0.010); eosinophils: PPL> UP, and TRANSPALB PCD (p = 0.010); granulation tissue: PPL and PCD> UP and TRANSPALB (p <0.001); macrophages : PPL, UP and PCD> TRANSPALB (p <0.001); lymphocytes: PPL and PCD> UP (p = 0.009) and TRANSPALB (p <0.001); giant cells: PPL, UP and PCD> TRANSPALB (p <0.001); viscera adhered: PPL and UP> PCD and TRANSPALB (p <0.001). CONCLUSION All types of meshes caused the formation of adhesions. The UP and PCD groups showed lower area and vascularization of the adhesions. The PPL and PCD groups showed higher meshes shrinkage and there was a predominance of acute inflammatory process in the PCD group.

Histopatologia do saco herniário da hérnia inguinal indireta e do peritônio parietal em adultos e crianças: estudo qualitativo da sua musculatura lisa

A prospective research was performed from April, 1993 through July, 1995 to study the histopathology of the hernial sac indirect inguinal hernias in adults and children, in order to verify the existence of smooth muscle, its incidence and morphological presentation, as well as to make a comparison to random biopsies of the parietal peritoneum. A number of 123 patients were assigned to group 1, where the hernial sacs were studied and 63 to group 2 where biopsies of the peritoneum of the abdominal cavity were performed. It was observed that a smooth muscle fibers occurred on 65,4% of patients from group 1 (ten of them with bilateral hernias) and on 19,04% of patients from group 2. The association among the occurrence of fibers of smooth muscle, the categorical variances (such as gender, skin complexion and side of hernia), and the continuous variances (patients age, lenth and width of the hernial sac) wer analyzed. Our results showed that the female gender presents a major incidence of smooth muscle fibers fibers (p=0,004) and also is 5,46 more likely to have smooth muscle fibers on the hernial sac. Therefore, the conclusion is that the smooth muscle fibers predominate in the parietal peritoneum of the lower abdomen and that there is greater quantity of smooth muscle fibers in the peritoneum of the inguinal hernial sac when compared to the parietal peritoneum.

Histopatologia do saco herniário das hérnias inguinais: a importância do conhecimento morfológico sacular

The hernial sac contents was always motive of concern by part of the surgeons, although still be little studied and known the structure of its wall. The purpose of this work was to evaluate the influences on the inguinal hernial sac of sex, color, age, region of hernial sac, hernia side, width, length, thickness in the presence of smooth muscle fibers (SMF). Also, it is intended to describe the structure of the hernial sacs studied and to present some theories on the SMF source, besides to emphasize the possible significance of knowledge on sacs structure to the hiden pathological condition, identification and the use of the sac itself as a reinforcement instrument on surgical corrections. Samples of 252 hernial sacs obtained during operative therapy of indirects, directs, relapsings, incarcerated inguinal hernias were sent to histopathological study when the samples were stained by Hematoxilin-Eosin (HE) and Gomori trichrome for SMF identification. These were present in 67,9% of the samples and they occurred significantly on indirects and relapsings when were compared to the directs and encarcerateds. With reference to the studied variables, the patients who presented SMF did not difer significantly from those in which the SMF were not found. When the SMF were present, it was often associated to thick blood vessels, suggesting its source from medial layer of vascular wall and might mean a tissue strength as response either to mechanical trauma or other factors of the hernia pathogenesis. It was observed, also, that the hernial sac may host many pathological processes which reach the parietal peritonium, as endometriosis, specific inflamations and hiperplasic processes or even neoplasics, including being able to constitute, in some instances, the first evidence of neoplasm.