• Raphael Nogueira do Amaral, TannuriAna Cristina AounACAProfessor, Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil., Junia Marielle Teixeira Rodrigues Neri, Hugo de Souza Reis, Josiane Oliveira Gonçalves, Suellen Serafini, and Uenis Tannuri.
• Medical Researcher, Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
• Clinics (Sao Paulo). 2022 Jan 1; 77: 100106.

BackgroundIncisional hernias are more frequent in adults than in children. It is hypothesized that a more efficient healing process in pediatric patients could explain this difference in incidence. Certain elements of healing such as neovascularization, degree of inflammation, percentage of mature and immature collagen, the proliferation of fibroblasts, and expression of certain genes could explain why healing in children is more efficient when compared to the adult and elderly populations.Materials And MethodsSeventy-one rats of 3 different age groups (weaning, adult, and old) underwent surgery with 3 different incisions (vertical, oblique, and horizontal). During the procedure, the skin and abdominal wall of the animal were sectioned and only the skin was sutured to mimic incisional hernia in the animals. Four weeks after surgery, the rats were euthanized, their skin was removed, and the extent of scar tissue formed in the muscle opening was measured. In addition, samples of the scar tissue were collected for histological, immunohistochemical, and molecular analyzes. Nine rats served as controls.ResultsShorter-length hernias were formed in weaning rats when compared to old ones when the surgical incision was horizontal (p = 0.03). There was a greater proliferation of fibroblasts in rats in the younger age groups, regardless of the type of incision. The Lox gene was more expressed in weaning rats with vertical and oblique incisions.ConclusionsThese differences could explain the better healing and lower incidence of hernias in the pediatric population, although this aspect requires further studies.Copyright © 2022 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

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