This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Connective tissue alteration in abdominal wall hernia. BJS 2011; 98: 210-219.
Published: 19th November 2010
Authors: N. A. Henriksen, D. H. Yadete, L. T. Sorensen, M. S. Ågren, L. N. Jorgensen
Background
The aetiology and pathogenesis of abdominal wall hernia formation is complex. Optimal treatment of hernias depends on a full understanding of the pathophysiological mechanisms involved in their formation. The aim of this study was to review the literature on specific collagen alterations in abdominal wall hernia formation.
Method
A computer‐assisted search of the medical databases PubMed and Embase was performed, together with a cross‐reference search of eligible papers.
Results
Fifty‐two papers were included. Collagen alteration depended on the type of hernia; there were more pronounced changes in patients with a direct inguinal hernia than in those with an indirect inguinal hernia, recurrent inguinal hernia or incisional hernia. A consistent finding was a significant increase in immature type III collagen relative to the stronger type I collagen in patients with a hernia. This resulted in thinner collagen fibres with a correspondingly diminished biomechanical strength. It has been suggested that these alterations are due to variation in the synthesis, maturation or degradation of collagen by matrix metalloproteinases, in combination or alone.
Conclusion
Hernia formation and recurrence is associated with altered collagen metabolism manifested by a decreased type I:III collagen ratio. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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