Skin biopsy as a method for determining indications for preventive endoprosthetics of the anterior abdominal wall

The aim is to examine the effectiveness of preoperative skin biopsy method to determine indications for preventive endoprosthesis implantation of the anterior abdominal wall based on structural features of connective tissue. 

Materials and methods. The study included 17 patients who had been planned to undergo a scheduled surgery such as video laparoscopic cholecystectomy. The histological material was collected with DERMO PUNCH biopsy needles in an outpatient clinic. Using polarized light microscopy we inspected histological slices coloured with Sirius red. After that we analyzed histological sections including the ratio of collagen fibers, the density of connective tissue and the number of interfibrous spaces. 

Results. All the studied features of connective tissue dysplasia had been registered among 18% of patients; significant differences (p ≤0.05) had been identified among other 24% of patients. In patients with identified signs of connective tissue dysplasia, an increase in type III collagen fibers and a decrease in type I fibers were revealed, which directly resulted in a decrease in their ratio. In addition, this category of patients noted a decrease in the density of connective tissue and a significant number of interfibrous spaces. 

Conclusion. Skin biopsy is a safe and informative method to reveal patients with predisposition to the formation of hernias of the anterior abdominal wall based on structural features of connective tissue and to determine indications for preventive endoprosthetic implantation. This method will reduce the frequency of postoperative ventral hernias, so the effectiveness of the treatment will definitely increase.

1. Иванов И.С., Лазаренко В.А., Иванов С.В., Горяинова Г.Н., Иванов А.В., Тарабрин Д.В., Литвякова М.И. Соотношение коллагена I и III типов в коже и апоневрозе у пациентов с вентральными грыжами. Новости хирургии. 2013;21(3):33-36. DOI: 10.18484/2305-0047.2013.3.33

2. Кириенко А.И., Никишков А.С., Селиверстов Е.И., Андрияшкин А.В. Эпидемиология грыж передней брюшной стенки. Эндоскопическая хирургия. 2016;22(4):55-60. DOI: 10.17116/endoskop201622455-60

3. Лазаренко В.А., Иванов С.В., Иванов И.С., Цуканов А.В., Горяйнова Г.Н., Объедков Е.Г. Определение показания к превентивному эндопротезированию на основании маркеров дисплазии соединительной ткани у больных с послеоперационными вентральными грыжами. Хирургия. Журнал им. Н.И. Пирогова. 2019;(8):12-16. DOI: 10.17116/hirurgia201908112

4. Люцко В.В. Биопсия кожи в дерматологии. Научно-практический рецензируемый журнал «Современные проблемы здравоохранения и медицинской статистики». 2015;(4):45-54

5. Blotta R.M., Costa S.D.S., Trindade E.N., Meurer L., Maciel-Trindade M.R. Collagen I and III in women with diastasis recti. Clinics (Sao Paulo). 2018;(73):e319. DOI: 10.6061/clinics/2018/e319.

6. Cunningham H.B., Weis J.J., Taveras L.R., Huerta S. Mesh migration following abdominal hernia repair: a comprehensive review. Hernia. 2019;23(2):235-243. DOI: 10.1007/s10029-019-01898-9

7. Fiori F., Ferrara F., Gentile D., Gobatti D., Stella M. Totally Endoscopic Sublay Anterior Repair for Ventral and Incisional Hernias. J Laparoendosc Adv Surg Tech A. 2019. DOI: 10.1089/lap.2018.0807

8. Garcia D.P., Santos C. Neto, Hubner P.N., Furtado Tde A., Petroianu A, Figueiredo L.O., Alberti L.R. Treatment of abdominal wall hernia with suture, or polypropylene, or collagen prosthesis. Acta Cir Bras. 2016;31(6):371-3376. DOI: 10.1590/S0102-865020160060000002

9. Helgstrand F. National results after ventral hernia repair. Dan Med J. 2016;63(7):B5258.

10. McGahan J.P. Challenges in abdominal/pelvic biopsy techniques. Abdom Imaging. 2013;38(5):1043-1056. DOI: 10.1007/s00261-013-0006-8

11. Miller H.J. Inguinal Hernia: Mastering the Anatomy. Surg Clin North Am. 2018;98(3):607-621. DOI: 10.1016/j.suc.2018.02.005

12. Mosanya A.O., Olasehinde O., Odujoko O.O., Etonyeaku A.C., Adumah C.C., Agbakwuru E.A. Comparative study of collagen and elastin content of abdominal wall fascia in inguinal hernia and non-hernia patients in an African population. Hernia. 2020;24(6):1337-1344. DOI: 10.1007/s10029-020-02238-y

13. Nishat R., Kumar H. Collagen fibers in oral submucous fibrosis - A polarizing microscopy study using two special stains. Indian J Pathol Microbiol. 2019;62(4):537-543. DOI: 10.4103/IJPM.IJPM_324_19

14. Patel K.M., Bhanot P. Complications of acellular dermal matrices in abdominal wall reconstruction. Plastic and Reconstructive Surgery. 2012;130(5-2):216-224. DOI: 10.1097/PRS.0b013e318262e186

15. Sabrina T., Erminia C., Giorgio T., Pierluigi I., Claudio M., Andrea M. Biological meshes for abdominal hernia: Lack of evidence-based recommendations for clinical use. International Journal of Surgery. 2018;(52):278-284. DOI: 10.1016/j.ijsu.2018.02.046