Abstract
Abdominal wall hernia is a multifactorial pathology involving both endogenous and exogenous factors. Male gender and familial history of inguinal hernia are important risk factors for primary inguinal hernia formation, whereas smoking and insufficient surgical technique is associated with recurrent inguinal hernia and incisional hernia formation. Moreover, alterations in collagen composition contribute to the formation of abdominal wall hernias. Apart from decreased levels of total collagen quantity in fascia, reduced collagen quality seems to be a key feature in many hernia patients. Especially, a decreased type I to III collagen ratio has been demonstrated in the fascia of patients with inguinal or incisional hernias, leading to thinner collagen fibers with less strength. These findings are also present in skin suggesting that abdominal wall hernia is a systemic disease. Increased collagen breakdown mediated by matrix metalloproteinase-2 (MMP-2) is suggested to be involved in inguinal hernia formation. Furthermore, systemically decreased type V collagen turnover leading to overall impaired collagen synthesis is present in patients with inguinal or incisional hernias. Published data point towards hernia disease as an inherited disease. The inheritance pattern and identification of gene defects for clinical use remain to be clarified.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Jansen PL, Mertens PP, Klinge U, Schumpelick V. The biology of hernia formation. Surgery. 2004;136(1):1–4. doi:10.1016/j.surg.2004.01.004.
Read RC. Arthur Keith, the anatomist who envisioned herniosis. Hernia. 2007;11(6):469–71. doi:10.1007/s10029-007-0273-9.
Stamenkovic I. Extracellular matrix remodelling: the role of matrix metalloproteinases. J Pathol. 2003;200(4):448–64. doi:10.1002/path.1400.
Henriksen NA, Yadete DH, Sorensen LT, Agren MS, Jorgensen LN. Connective tissue alteration in abdominal wall hernia. Br J Surg. 2011;98(2):210–9. doi:10.1002/bjs.7339.
Kadler KE, Baldock C, Bella J, Boot-Handford RP. Collagens at a glance. J Cell Sci. 2007;120(Pt 12):1955–8. doi:10.1242/jcs.03453.
Murphy G, Nagase H. Progress in matrix metalloproteinase research. Mol Aspects Med. 2008;29(5):290–308. doi:10.1016/j.mam.2008.05.002.
Zoller B, Ji J, Sundquist J, Sundquist K. Shared and nonshared familial susceptibility to surgically treated inguinal hernia, femoral hernia, incisional hernia, epigastric hernia, and umbilical hernia. J Am Coll Surg. 2013;217(2):289–99.e1. doi:10.1016/j.jamcollsurg.2013.04.020.
Henriksen NA, Helgstrand F, Vogt KC, Jorgensen LN, Bisgaard T. Risk factors for incisional hernia repair after aortic reconstructive surgery in a nationwide study. J Vasc Surg. 2013;57(6):1524–30e1–3. doi:10.1016/j.jvs.2012.11.119.
Thomas GP, Purkayastha S, Athanasiou T, Darzi A. General surgical manifestations of Marfan’s syndrome. Br J Hosp Med. 2008;69(5):270–4.
Liem MS, van der Graaf Y, Beemer FA, van Vroonhoven TJ. Increased risk for inguinal hernia in patients with Ehlers-Danlos syndrome. Surgery. 1997;122(1):114–5.
Girotto JA, Malaisrie SC, Bulkely G, Manson PN. Recurrent ventral herniation in Ehlers-Danlos syndrome. Plast Reconstr Surg. 2000;106(7):1520–6.
Ruhl CE, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. 2007;165(10):1154–61. doi:10.1093/aje/kwm011.
Henriksen NA, Sorensen LT, Bay-Nielsen M, Jorgensen LN. Direct and recurrent inguinal hernias are associated with ventral hernia repair: a database study. World J Surg. 2013;37(2):306–11. doi:10.1007/s00268-012-1842-3.
Alnassar S, Bawahab M, Abdoh A, Guzman R, Al Tuwaijiri T, Louridas G. Incisional hernia postrepair of abdominal aortic occlusive and aneurysmal disease: five-year incidence. Vascular. 2012;20(5):273–7. doi:10.1258/vasc.2011.oa0332.
Burcharth J, Pommergaard HC, Rosenberg J. The inheritance of groin hernia: a systematic review. Hernia. 2013;17(2):183–9. doi:10.1007/s10029-013-1060-4.
Jones ME, Swerdlow AJ, Griffith M, Goldacre MJ. Risk of congenital inguinal hernia in siblings: a record linkage study. Paediatr Perinat Epidemiol. 1998;12(3):288–96.
Sawaguchi S, Matsunaga E, Honna T. A genetic study on indirect inguinal hernia. Jinrui Idengaku Zasshi. 1975;20(3):187–95.
Rowe MI, Copelson LW, Clatworthy HW. The patent processus vaginalis and the inguinal hernia. J Pediatr Surg. 1969;4(1):102–7.
Koch A, Edwards A, Haapaniemi S, Nordin P, Kald A. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg. 2005;92(12):1553–8. http://dx.doi.org/10.1002/bjs.5156.
Sezer S, Simsek N, Celik HT, Erden G, Ozturk G, Duzgun AP, et al. Association of collagen type I alpha 1 gene polymorphism with inguinal hernia. Hernia. 2014;18(4):507–12. doi:10.1007/s10029-013-1147-y.
Rodrigues C, Yoo J, Rodrigues Jr A. Elastin (ELN) gene point mutation in patients with inguinal hernia. Genet Mol Biol. 2006;29(1):45–6. http://dx.doi.org/10.1590/S1415-47572006000100009.
Jorgenson E, Makki N, Shen L, Chen DC, Tian C, Eckalbar WL, et al. A genome-wide association study identifies four novel susceptibility loci underlying inguinal hernia. Nat Commun. 2015;6:10130. doi:10.1038/ncomms10130.
Calaluce R, Davis JW, Bachman SL, Gubin MM, Brown JA, Magee JD, et al. Incisional hernia recurrence through genomic profiling: a pilot study. Hernia. 2013;17(2):193–202. doi:10.1007/s10029-012-0923-4.
Wagh PV, Leverich AP, Sun CN, White HJ, Read RC. Direct inguinal herniation in men: a disease of collagen. J Surg Res. 1974;17(6):425–33.
Rodrigues Jr AJ, Rodrigues CJ, da Cunha AC, Jin Y. Quantitative analysis of collagen and elastic fibers in the transversalis fascia in direct and indirect inguinal hernia. Rev Hosp Clin Fac Med Sao Paulo. 2002;57(6):265–70.
Ozdogan M, Yildiz F, Gurer A, Orhun S, Kulacoglu H, Aydin R. Changes in collagen and elastic fiber contents of the skin, rectus sheath, transversalis fascia and peritoneum in primary inguinal hernia patients. Bratisl Lek Listy. 2006;107(6–7):235–8.
Casanova AB, Trindade EN, Trindade MR. Collagen in the transversalis fascia of patients with indirect inguinal hernia: a case-control study. Am J Surg. 2009;198(1):1–5. doi:10.1016/j.amjsurg.2008.07.021.
Pans A, Albert A, Lapiere CM, Nusgens B. Biochemical study of collagen in adult groin hernias. J Surg Res. 2001;95(2):107–13. doi:10.1006/jsre.2000.6024.
Meyer AL, Berger E, Monteiro Jr O, Alonso PA, Stavale JN, Goncalves MP. Quantitative and qualitative analysis of collagen types in the fascia transversalis of inguinal hernia patients. Arq Gastroenterol. 2007;44(3):230–4.
Szczesny W, Glowacka K, Marszalek A, Gumanski R, Szmytkowski J, Dabrowiecki S. The ultrastructure of the fascia lata in hernia patients and healthy controls. J Surg Res. 2012;172(1):e33–7. doi:10.1016/j.jss.2011.09.004.
Amato G, Agrusa A, Romano G, Salamone G, Gulotta G, Silvestri F, et al. Muscle degeneration in inguinal hernia specimens. Hernia. 2012;16(3):327–31. doi:10.1007/s10029-011-0890-1.
Friedman DW, Boyd CD, Norton P, Greco RS, Boyarsky AH, Mackenzie JW, et al. Increases in type III collagen gene expression and protein synthesis in patients with inguinal hernias. Ann Surg. 1993;218(6):754–60.
Rosch R, Junge K, Knops M, Lynen P, Klinge U, Schumpelick V. Analysis of collagen-interacting proteins in patients with incisional hernias. Langenbecks Arch Surg. 2003;387(11–12):427–32. doi:10.1007/s00423-002-0345-3.
Klinge U, Si Z, Zheng H, Schumpelick V, Bhardwaj R, Klosterhalfen B. Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg. 2001;14(1):47–54. http://dx.doi.org/10.1080/089419301750072202.
Si Z, Bhardwaj R, Rosch R, Mertens PR, Klosterhalfen B, Klinge U. Impaired balance of type I and type III procollagen mRNA in cultured fibroblasts of patients with incisional hernia. Surgery. 2002;131(3):324–31.
Peeters E, De Hertogh G, Junge K, Klinge U, Miserez M. Skin as marker for collagen type I/III ratio in abdominal wall fascia. Hernia. 2013. doi:10.1007/s10029-013-1128-1.
Pascual G, Rodriguez M, Mecham RP, Sommer P, Bujan J, Bellon JM. Lysyl oxidase like-1 dysregulation and its contribution to direct inguinal hernia. Eur J Clin Invest. 2009;39(4):328–37. doi:10.1111/j.1365-2362.2009.02099.x.
Henriksen NA, Mortensen JH, Sorensen LT, Bay-Jensen AC, Agren MS, Jorgensen LN, et al. The collagen turnover profile is altered in patients with inguinal and incisional hernia. Surgery. 2015;157(2):312–21. doi:10.1016/j.surg.2014.09.006.
Henriksen NA, Mortensen JH, Lorentzen L, Agren MS, Bay-Jensen AC, Jorgensen LN, et al. Abdominal wall hernias-A local manifestation of systemically impaired quality of the extracellular matrix. Surgery. 2016. doi:10.1016/j.surg.2016.02.011.
Jain V, Srivastava R, Jha S, Misra S, Rawat NS, Amla DV. Study of matrix metalloproteinase-2 in inguinal hernia. J Clin Med Res. 2009;1(5):285–9. doi:10.4021/jocmr2009.12.1281.
Smigielski J, Kolomecki K, Ziemniak P, Drozda R, Amsolik M, Kuzdak K. Degradation of collagen by metalloproteinase 2 in patients with abdominal hernias. Eur Surg Res. 2009;42(2):118–21. doi:10.1159/000187643.
Pascual G, Rodriguez M, Gomez-Gil V, Trejo C, Bujan J, Bellon JM. Active matrix metalloproteinase-2 upregulation in the abdominal skin of patients with direct inguinal hernia. Eur J Clin Invest. 2010;40(12):1113–21. doi:10.1111/j.1365-2362.2010.02364.x.
Jensen KK, Krarup PM, Scheike T, Jorgensen LN, Mynster T. Incisional hernias after open versus laparoscopic surgery for colonic cancer: a nationwide cohort study. Surg Endosc. 2016. doi:10.1007/s00464-016-4779-z.
Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms. J Int Med Res. 2009;37(5):1528–42.
Oryan A. Role of collagen in soft connective tissue wound healing. Transplant Proc. 1995;27(5):2759–61.
Sorensen L, Friis E, Jorgensen T, Vennits B, Andersen B, Rasmussen G, et al. Smoking is a risk factor for recurrence of groin hernia. World J Surg. 2002;26(4):397–400.
Sorensen L, Hemmingsen U, Kirkeby L, Kallehave F, Jorgensen L. Smoking is a risk factor for incisional hernia. Arch Surg. 2005;140(2):119–23. http://dx.doi.org/10.1001/archsurg.140.2.119.
Jorgensen LN, Kallehave F, Karlsmark T, Gottrup F. Reduced collagen accumulation after major surgery. Br J Surg. 1996;83(11): 1591–4.
Sorensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012;255(6):1069–79. doi:10.1097/SLA.0b013e31824f632d.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Henriksen, N.A., Jensen, K.K., Jorgensen, L.N. (2017). The Biology of Hernia Formation. In: Hope, W., Cobb, W., Adrales, G. (eds) Textbook of Hernia. Springer, Cham. https://doi.org/10.1007/978-3-319-43045-4_1
Download citation
DOI: https://doi.org/10.1007/978-3-319-43045-4_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-43043-0
Online ISBN: 978-3-319-43045-4
eBook Packages: MedicineMedicine (R0)