Abstract
The fundamental mechanism for hernia formation is loss of the mechanical integrity of abdominal wall structural tissue that results in the inability to offset and contain intra-abdominal forces during valsalva and loading of the torso. There is evidence that genetic or systemic extracellular matrix disorders may predispose patients to hernia formation. There is also evidence that acute laparotomy wound failure leads to hernia formation and increases the risk of recurrent hernia disease. It may be that hernia formation is a heterogeneous disease, not unlike cancer, where one population of patients express an extracellular matrix defect leading to primary hernia disease, while other subsets of patients acquire a defective, chronic wound phenotype following failed laparotomy and hernia repairs. It is evident that an improved understanding of structural tissue matrix biology will lead to improved results following abdominal wall reconstructions.
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References
Read RC (2002) Why do human beings develop groin hernias? In: Fitzgibbons RJ Jr, Greenburg AG (eds) Nyhus and Condon’s hernia, 5th edn. Lippincott, Philadelphia, pp 1–8
Peacock EE, Madden JW (1974) Studies on the biology and treatment of recurrent inguinal hernia II. Morphological changes. Ann Surg 179:567–571
Klinge U, Zheng H, Si ZY, Schumpelick V, Bhardwaj R, Klosterhalfen B (1999) Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases-1 and -13 in hernial sac of patients with inguinal hernia. Int J Surg Investig 1(3):219–227
Junge K, Klinge U, Rosch R, Mertens PR, Kirch J, Klosterhalfen B et al (2004) Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg 389(1):17–22
Duncan RL, Turner CH (1995) Mechanotransduction and the functional response of bone to mechanical strain. Calcif Tissue Int 57:344–358
Skutek M, van Griensven M, Zeichen J, Brauer N, Bosch U (2001)Cyclic mechanical stretching modulates secretion pattern of growth factors in human tendon fibroblasts. Eur J Appl Physiol 86(1):48–52
Katsumi A, Orr AW, Tzima E, Schwartz MA (2004) Integrins in mechanotransduction. J Biol Chem 279(13):12001–12004
Sorensen LT, Jorgensen LN, Gottrup F (2002) Biochemical aspects of abdominal wall hernia formation and recurrence. In: Fitzgibbons RJ Jr, Greenburg AG (eds) Nyhus and condon’s hernia, 5th edn. Lippincott, Philadelphia, pp 9–16
Dubay DA,Wang X, Kirk S, Adamson B, Robson MC, Franz MG (2004) Fascial fibroblast kinetic activity is increased during abdominal wall repair compared to dermal fibroblasts. Wound Rep Regen 12(5):539–545
DuBay DA, Wang X, Adamson B, Kuzon WM Jr, Dennis RG, Franz MG (2005) Progressive fascial wound failure impairs subsequent abdominal wall repairs: a new animal model of incisional hernia formation. Surgery 137(4):463–471
Benjamin M, Hillen B (2003) Mechanical influences on cells, tissues and organs—‘Mechanical morphogenesis’. Eur J Morphol 41(1):3–7
Pollock AV, Evans M (1989) Early prediction of late incisional hernias. Br J Surg 76:953–954
Santora TA, Rosylyn JJ (1993) Incisional hernia. Hernia surgery. Surg Clin N Am 73(3):557–570
Peacock Jr EE (1984) Fascia and muscle. In: Peacock EE Jr (ed) Wound repair, 3rd edn. Saunders, Philadelphia, pp 332–362
Luijendijk RW, Hop WCJ, van den Tol MP, de Lange DCD, Braaksma MMJ, Ijezermans JNM et al (2000) A comparison of suture repair with mesh repair for incisional hernia. NEJM 343(6):392–398
Korenkov M, Sauerland S, Arndt M, Bograd L, Neugebauer EAM, Troidl H (2002) Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia. Br J Surg 89(1):50–56
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):427–432
Junge K, Klinge U, Klosterhalfen B, Rosch R, Stumpf M, Schumpelick V (2002) review of wound healing with reference to an unrepairable abdominal hernia. Eur J Surg 168(2):67–73
Bellon JM, Bajo A, Ga-Honduvilla N, Gimeno MJ, Pascual G, Guerrero A et al (2001) Fibroblasts from the transversalis fascia of young patients with direct inguinal hernias show constitutive mmp-2 overexpression. Ann Surg 233(2):287–291
Robson MC, Steed DL, Franz MG (2001) Wound healing: biologic features and approaches to maximize healing trajectories. Curr Probl Surg 38:117–122
Prockop DJ, Kivirikko KI, Tuderman L et al (1979) The biosynthesis of collagen and its disorders. NEJM 301:13–23
Carlson MA (2001) Acute wound failure. Wound healing. Surg Clin N Am 77:607–635
Riches DWH (1995) Macrophage involvement in wound repair, remodeling and fibrosis. In: Clark RAF (ed) The molecular and cellular biology of wound repair, 2nd edn. Plenum, New York, pp 95–141
Levenson SM, Demetriou AA (2001) Metabolic factors. In: Cohen IH, Diegelmann RF, Lindblad WJ (eds) Wound healing: biochemical and clinical aspects. Saunders, Philadelphia, pp 248–273
Ferguson MW, Whitby DJ, Shah M et al (1996) Scar formation: the spectral nature of fetal and adult wound repair. Plast Reconstr Surg 97:854–860
Morgan CJ, Pledger WJ (1992) Fibroblast proliferation. In: Cohen IH, Diegelmann RF, Lindblad WJ (eds) Wound healing: biochemical and clinical aspects, 1st edn. Saunders, Philadelphia, pp 63–76
Vande Berg J, Smith PD, Haywood-Reid PL et al (2001) Dynamic forces in the cell cycle affecting fibroblasts in pressure ulcers. Wound Rep Reg 9:19–27
Ellis H, Harrison W, Hugh TB (1965) The healing of peritoneum under normal and pathological conditions. Br J Surg 52:471
Read RC (2003) Recent advances in the repair of groin herniation. Curr Probl Surg 40:1–80
Hall KA, Peters B, Smyth SH et al (1995) Abdominal wall hernias in patients with abdominal aortic aneurysm versus aortoiliac occlusive disease. Am J Surg 170:572
Viidik A, Gottrup F (1986) Mechanics of healing soft tissue wounds. In: Schmid-Schonbein GW, Woosly SLY, Zweifach WB (eds) Frontiers in biomechanics. Spinger, Berlin Heidelberg New York
Cromack DT, Sporn MB, Roberts AB et al (1987) Transforming growth factor beta levels in rat wound chambers. J Surg Res 42:622–628
Mustoe TA, Pierce GF, Thomason A et al (1987) Accelerated healing of incisional wounds in rats induced by transforming growth factor-β. Science 237:1333–1336
Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population based analysis. Ann Surg 237(1):129–135
Mudge M, Hughes LE (1985) Incisional hernia: a 10 Year prospective study of incidence and attitudes. Br J Surg 72(1):70–71
Jenkins TPN (1980) Incisional hernia repair: a mechanical approach. Br J Surg 67(5):335–336
Gislason H, Gronbech JE, Soreide O (1995) Burst abdomen and incisional hernia after major gastrointestinal operations: comparison of 3 closure techniques. Eur J Surg 161(5):349–354
Schmidt C, Pommerenke H, Durr F et al (1998) Mechanical stressing of integrin receptors induces enhanced tyrosine phosphorylation of cytoskeletally anchored proteins. J Biol Chem 273:5081–5085
DuBay DA, Choi W, Urbanchek MG, Wang X, Adamson B, Chung E, Dennis RG, Kuzon WM, Franz MG (2006) Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg (in press)
DuBay D, Wang X, Adamson B, Kuzon WMJr, Dennis RG, Franz MG (2005) Mesh incisional herniorrhaphy improves wound mechanical properties following abdominal wall reconstruction. Surgery (in press)
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Franz, M.G. The biology of hernias and the abdominal wall. Hernia 10, 462–471 (2006). https://doi.org/10.1007/s10029-006-0144-9
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DOI: https://doi.org/10.1007/s10029-006-0144-9