Collagen Deposition in Ilioinguinal Nerves from Primary Inguinal Hernia Patients
Robert C Wright, MD, FACS, Cascade Hernia Institute, Puyallup, WA, Troy Sanders, BS, Elson Floyd School of Medicine, Spokane, WA, Donald Born, MD, PhD, Stanford University, Stanford, CA and Anjali Kumar, MD, MPH, FACS, Elson S Floyd College of Medicine, Spokane, WA
Collagen Deposition in Ilioinguinal Nerves from Primary Inguinal Hernia Patients Background: Pre-operative pain is a common occurrence in inguinal hernia, however the source of this pain is poorly understood. It has been suggested that this pain may be due to hernia related chronic pressure on the ilioinguinal nerve, a form of compression neuropathy. Our hypothesis is that increased collagen can be found in the nerve segments with hernia related pressure related to fibrosis. Methods: We prospectively recruited 28 patients undergoing primary inguinal herniorrhaphy for ilioinguinal neurectomy and evaluation. Three segments of the nerve were paraffin-embedded and sectioned with Gomori’s trichome staining: 1=protected proximal region (nerve not in contact with hernia tissue); and nerve in contact with hernia 2=inguinal canal and 3=distal to the external inguinal ring. We analyzed digitized slides with Fiji software using color deconvolution. We quantified nerve fascicle area and its collagen content. Statistical calculations (t.test and Spearman rank) determined significant differences among groups at p<0.05. Results: We found collagen content in the inguinal canal nerve increased compared to the proximal control (p<0.02). There was no significant difference in the collagen content in the distal nerve when compared to the proximal (p=0.08). Total area, specific to the fascicles in the canal segment, demonstrated an increased total cross-sectional area compared to the proximal control (p<0.04). Further, the canal segment was smaller in total cross-sectional area than the proximal control (p<0.006) or the distal segment (p<0.04). Conclusions: In primary inguinal hernia, increased collagen content in the ilioinguinal nerve is demonstrated in the region affected by the hernia, particularly in the inguinal canal ring. This is consistent with compressive neuropathy.
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