Summary
The aim of this study was to substantiate the hypothesis as to whether an altered metabolism of type I and type III collagen should be included as pathophysiological considerations of inguinal hernia development or not. Therefore, fascia transversalis derived from patients with indirect hernias (n=9), direct hernias (n=7) and from controls (n=7) were investigated both by immunohistochemistry and protein analysis (Western Blot). Both immunohistochemical analysis and Western Blot analysis showed that the ratio of the relative amounts of type I to type III collagen was significantly decreased in the fascia transversalis of patients with indirect and direct inguinal hernias compared with controls (p<0.001). The relative reduction of the collagen I/III ratio may be explained by a concomitant increase in collagen type III synthesis in both hernia-families. In contrast to the control group there was no significant difference between patients with direct and indirect hernia. It is concluded that the change in collagen type I / III ratio, with the resulting altered physical properties, might essentially predispose individuals to the development of inguinal hernia. Thus, an altered collagen metabolism would provide an additional theoretical basis for the use of alloplastic materials, such as surgical meshes, and an explanation for the disappointing high recurrence rates after appropriate primary hernia repair, particularly if mesh-free techniques have been used.
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Klinge, U., Zheng, H., Si, Z.Y. et al. Altered collagen synthesis in fascia transversalis of patients with inguinal hernia. Hernia 3, 181–187 (1999). https://doi.org/10.1007/BF01194422
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DOI: https://doi.org/10.1007/BF01194422