# Crosslinking Surgical Oncology and the Assessments of Hernia Sac Tissues With Malignant Transformations

## TL;DR

This study found early signs of cancer-like changes in hernia sac tissues, suggesting the need for routine microscopic evaluation during hernia repairs.

## Contribution

The study introduces a method to detect early pre-malignant changes in hernia sac tissues during surgical procedures.

## Key findings

- 34% of hernia sac tissues showed chronic inflammation, and 21.3% showed mesothelial hyperplasia.
- 7.5% of hernia sac tissues exhibited atypical cellular changes suspicious for neoplastic transformation.
- Hernia group showed significantly higher fibrotic thickening, vascular changes, and cellular atypia compared to controls.

## Abstract

Background: Hernia repairs are performed frequently, yet studies investigating the presence of malignancies within hernia sac tissues during these operations remain limited. The research investigated histopathological changes in hernia sac tissues, along with early signs of malignancy, while integrating surgical oncology practices with diagnostic pathological examinations.

Methods: This prospective observational study included 100 adult patients who underwent abdominal surgery between January and September 2022. Eighty candidates undergoing elective hernia repair surgery participated in this study, along with 20 patients with age and sex similarities undergoing unrelated abdominal surgeries. Sample size was calculated using OpenEpi software version 3.0.0 (Dean, Sullivan, Soe: Atlanta, GA). General evaluation of the hernia sac tissue involved the examination of chronic inflammation, mesothelial hyperplasia, atypical cellular changes, fibrosis, and vascular proliferation. Statistical analysis was done using SPSS version 26 (Armonk, NY: IBM Corp.) with a p-value of <0.05 considered statistically significant.

Results: Out of the total participants in the hernia group, 34 (42.5%) showed chronic inflammatory infiltration, while 17 (21.3%) exhibited mesothelial hyperplasia. Early atypical cellular architecture, suspicious for neoplastic transformation, was found in six cases (7.5%). Pathological analysis revealed that subjects from the hernia group presented with significantly higher rates of fibrotic thickening (p=0.021), vascular changes (p=0.034), and cellular atypia (p=0.011). All samples collected from the control group demonstrated no signs of malignant development.

Conclusion: The analysis of hernia sac tissue showed early signs that indicate potential pre-malignant changes under specific circumstances. Due to its capacity to spot early signs of cancer, the routine practice of microscopic evaluation enables better disease monitoring in surgical patients.