Advertisement

Surgical Endoscopy

, Volume 25, Issue 5, pp 1390–1394 | Cite as

Collagen type I:III ratio of the gastroesophageal junction in patients with paraesophageal hernias

  • Shaun R. Brown
  • Lora Melman
  • Eric Jenkins
  • Corey Deeken
  • Margaret M. Frisella
  • L. Michael Brunt
  • J. Christopher Eagon
  • Brent D. Matthews
Article

Abstract

Background

The purpose of this study was to examine the biological environment of the esophageal hiatus through analysis of the collagen content within the gastrohepatic ligament (GHL), gastrophrenic ligament (GPL), and phrenoesophageal ligament (PEL) in patients with type I hiatal hernias (HH) and type III paraesophageal hernias (PEH).

Methods

A control group (N = 10) and patients with type I HH (N = 10) and type III PEH (N = 10) were included in the analysis. Specimens of the GHL, PEL, and GPL were collected intraoperatively. Slides stained with sirius red/fast green were created and ten photos at 400 × magnification were taken of each specimen. Axiovision 4.7 (Zeiss) photo analysis software was employed for quantification of collagen I (red) and III (green) by calculating color area (μm2). Statistical significance (p < 0.05) was determined using a one-way ANOVA and Fisher’s LSD post-test.

Results

Cross-polarization microscopy revealed that the collagen I content was similar in the three study groups for the GHL, greater in the type III PEH group and in the control group compared to the type I HH group for the PEL, and greater in the type III PEH group compared to control group for the GPL. Collagen III quantity was greater in the control group than in the type I HH group for each ligament, and greater in the GHL and PEL when compared to the type III PEH group. Type III PEH patients had greater collagen III quantity than did type I HH patients for each ligament. Collagen type I:III ratio of the GHL was greater in both hernia groups compared to the control group. Type III PEH patients contained a higher I:III ratio than both the control and type I HH groups with respect to the PEL. There was no difference in the ratio with evaluation of the GPL for the three groups.

Conclusion

Evaluation of the esophageal hiatus revealed that patients with PEH have a different biological environment with regard to collagen content compared to control patients. The collagen I:III ratio of the study groups was equal to or greater than the control group. Collagen deficiency in the GE junction supporting ligaments does not appear to be an etiology of PEH formation.

Keywords

Paraesophageal hernia Collagen ratio Collagen I Collagen III 

Notes

Acknowledgment

This work was funded by the Musculoskeletal Transplantation Foundation.

Disclosures

Dr. Brown, Dr. Melman, Dr. Jenkins, and Mrs. Frisella have no conflicts of interest or financial ties to disclose. Dr. Deeken has received consulting fees and an honorarium from Davol, Incorporated. Dr. Eagon is a consultant for Ethicon Endosurgical. Dr. Brunt has received educational grants and research support from Ethicon Endosurgical, Karl Storz Endoscopy, Stryker endoscopy, and Lifecell, and an honorarium for speaking from Ethicon EndoSurgery. Dr. Matthews has received consulting fees from Atrium Medical, Ethicon EndoSurgery, and Muskuloskeletal Transplant Foundation, and an honorarium for speaking from W.L. Gore.

References

  1. 1.
    Berstad A, Weberg R, Froyshov Larsen I, Hoel B, Hauer-Jensen M (1986) Relationship of hiatus hernia to reflux oesophagitis. A prospective study of coincidence, using endoscopy. Scand J Gastroenterol 21(1):55–58PubMedCrossRefGoogle Scholar
  2. 2.
    Soper NJ (1999) Laparoscopic management of hiatal hernia and gastroesophageal reflux. Curr Probl Surg 36(10):765–838PubMedGoogle Scholar
  3. 3.
    Hashemi M, Sillin LF, Peters JH (1999) Current concepts in the management of paraesophageal hiatal hernia. J Clin Gastroenterol 29(1):8–13PubMedCrossRefGoogle Scholar
  4. 4.
    El Sherif A, Yano F, Mittal S, Filipi CJ (2006) Collagen metabolism and recurrent hiatal hernia: cause and effect? Hernia 10(6):511–520PubMedCrossRefGoogle Scholar
  5. 5.
    Junge K, Klinge U, Rosch R, Lynen P, Binnebosel M, Conze J, Mertens PR, Schwab R, Schumpelick V (2007) Improved collagen type I/III ratio at the interface of gentamicin-supplemented polyvinylidenfluoride mesh materials. Langenbecks Arch Surg 392(4):465–471PubMedCrossRefGoogle Scholar
  6. 6.
    Junge K, Klinge U, Rosch R, Mertens PR, Kirch J, Klosterhalfen B, Lynen P, Schumpelick V (2004) Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg 389(1):17–22PubMedCrossRefGoogle Scholar
  7. 7.
    Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2000) Abnormal collagen I to III distribution in the skin of patients with incisional hernia. Eur Surg Res 32(1):43–48PubMedCrossRefGoogle Scholar
  8. 8.
    Klinge U, Binnebosel M, Mertens PR (2006) Are collagens the culprits in the development of incisional and inguinal hernia disease? Hernia 10(6):472–477PubMedCrossRefGoogle Scholar
  9. 9.
    Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2001) Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg 14(1):47–54PubMedCrossRefGoogle Scholar
  10. 10.
    Girotto JA, Malaisrie SC, Bulkely G, Manson PN (2000) Recurrent ventral herniation in Ehlers-Danlos syndrome. Plast Reconstr Surg 106(7):1520–1526PubMedCrossRefGoogle Scholar
  11. 11.
    Uden A, Lindhagen T (1988) Inguinal hernia in patients with congenital dislocation of the hip. A sign of general connective tissue disorder. Acta Orthop Scand 59(6):667–668PubMedCrossRefGoogle Scholar
  12. 12.
    Si Z, Bhardwaj R, Rosch R, Mertens PR, Klosterhalfen B, Klinge U (2002) Impaired balance of type I and type III procollagen mRNA in cultured fibroblasts of patients with incisional hernia. Surgery 131(3):324–331PubMedCrossRefGoogle Scholar
  13. 13.
    Rosch R, Klinge U, Si Z, Junge K, Klosterhalfen B, Schumpelick V (2002) A role for the collagen I/III and MMP-1/-13 genes in primary inguinal hernia? BMC Med Genet 3:2PubMedCrossRefGoogle Scholar
  14. 14.
    Junqueira LC, Bignolas G, Brentani RR (1979) Picrosirius staining plus polarization microscopy, a specific method for collagen detection in tissue sections. Histochem J 11(4):447–455PubMedCrossRefGoogle Scholar
  15. 15.
    Basson MD (2003) Invited research review: cell–matrix interactions in the gut epithelium. Surgery 133(3):263–267PubMedCrossRefGoogle Scholar
  16. 16.
    Friedman DW, Boyd CD, Norton P, Greco RS, Boyarsky AH, Mackenzie JW, Deak SB (1993) Increases in type III collagen gene expression and protein synthesis in patients with inguinal hernias. Ann Surg 218(6):754–760PubMedCrossRefGoogle Scholar
  17. 17.
    Krane SM, Byrne MH, Lemaitre V, Henriet P, Jeffrey JJ, Witter JP, Liu X, Wu H, Jaenisch R, Eeckhout Y (1996) Different collagenase gene products have different roles in degradation of type I collagen. J Biol Chem 271(45):28509–28515PubMedCrossRefGoogle Scholar
  18. 18.
    Arakawa M, Hatamochi A, Mori Y, Mori K, Ueki H, Moriguchi T (1996) Reduced collagenase gene expression in fibroblasts from hypertrophic scar tissue. Br J Dermatol 134(5):863–868PubMedCrossRefGoogle Scholar
  19. 19.
    Schaffer M, Becker HD (1999) [Immune regulation of wound healing]. Chirurg 70(8):897–908PubMedCrossRefGoogle Scholar
  20. 20.
    Hurme T, Kalimo H, Sandberg M, Lehto M, Vuorio E (1991) Localization of type I and III collagen and fibronectin production in injured gastrocnemius muscle. Lab Invest 64(1):76–84PubMedGoogle Scholar
  21. 21.
    Lehto M, Sims TJ, Bailey AJ (1985) Skeletal muscle injury—molecular changes in the collagen during healing. Res Exp Med (Berl) 185(2):95–106CrossRefGoogle Scholar
  22. 22.
    Stadelmann WK, Digenis AG, Tobin GR (1998) Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg 176(2A Suppl):26S–38SPubMedCrossRefGoogle Scholar
  23. 23.
    Klinge U, Zheng H, Si Z, Schumpelick V, Bhardwaj RS, Muys L, Klosterhalfen B (1999) Expression of the extracellular matrix proteins collagen I, collagen III and fibronectin and matrix metalloproteinase-1 and -13 in the skin of patients with inguinal hernia. Eur Surg Res 31(6):480–490PubMedCrossRefGoogle Scholar
  24. 24.
    Rosch R, Lynen-Jansen P, Junge K, Knops M, Klosterhalfen B, Klinge U, Mertens PR, Schumpelick V (2006) Biomaterial-dependent MMP-2 expression in fibroblasts from patients with recurrent incisional hernias. Hernia 10(2):125–130PubMedCrossRefGoogle Scholar
  25. 25.
    Rosch R, Junge K, Knops M, Lynen P, Klinge U, Schumpelick V (2003) Analysis of collagen-interacting proteins in patients with incisional hernias. Langenbecks Arch Surg 387(11–12):427–432PubMedGoogle Scholar
  26. 26.
    Melman L, Chisholm PR, Curci JA, Arif B, Pierce R, Jenkins ED, Brunt LM, Eagon C, Frisella M, Miller K, Matthews BD (2010) Differential regulation of MMP-2 in the gastrohepatic ligament of the gastroesophageal junction. Surg Endosc 24(7):1562–1565PubMedCrossRefGoogle Scholar
  27. 27.
    Curci JA, Melman LM, Thompson RW, Soper NJ, Matthews BD (2008) Elastic fiber depletion in the supporting ligaments of the gastroesophageal junction: a structural basis for the development of hiatal hernia. J Am Coll Surg 207(2):191–196PubMedCrossRefGoogle Scholar
  28. 28.
    Asling B, Jirholt J, Hammond P, Knutsson M, Walentinsson A, Davidson G, Agreus L, Lehmann A, Lagerström-Fermer M (2009) Collagen type III alpha I is a gastro-oesophageal reflux disease susceptibility gene and a male risk factor for hiatus hernia. Gut 58(8):1063–1069PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Shaun R. Brown
    • 1
  • Lora Melman
    • 1
  • Eric Jenkins
    • 1
  • Corey Deeken
    • 1
  • Margaret M. Frisella
    • 1
  • L. Michael Brunt
    • 1
  • J. Christopher Eagon
    • 1
  • Brent D. Matthews
    • 1
  1. 1.Section of Minimally Invasive Surgery, Department of SurgeryWashington University School of MedicineSt. LouisUSA

Personalised recommendations