http://www.guarnieriherniacenter.com/pages/book/eng.pdf

With the collaboration of

The authors examined risk factors for incident inguinal hernia among US adults (5,316 men and 8,136 women) participating in the First National Health and Nutrition Examination Survey (1971-1975) who were followed through 1992-1993 for a hospital (International Classification of Diseases, Ninth Revision, Clinical Modification, code 550) or physician diagnosis of inguinal hernia. Ninety-six percent of the baseline cohort was recontacted, with a median follow-up of 18.2 years (range, 0.02-22.1 years). Because the cumulative incidence of inguinal hernia was higher among men (13.9%) than among women (2.1%), more detailed analyses were conducted in men. Among men in multivariate analysis, a higher incidence (p < 0.05) of inguinal hernia was associated with an age of 40-59 years (hazard ratio (HR) = 2.2, 95% confidence interval (CI): 1.7, 2.8), an age of 60-74 years (HR = 2.8, 95% CI: 2.2, 3.6), and hiatal hernia (HR = 1.8, 95% CI: 1.2, 2.7), while Black race (HR = 0.58, 95% CI: 0.42, 0.79), being overweight (HR = 0.79, 95% CI: 0.66, 0.95), and obesity (HR = 0.51, 95% CI: 0.36, 0.71) were associated with a lower incidence. Among women, older age, rural residence, greater height, chronic cough, and umbilical hernia were associated with inguinal hernia. In the United States, inguinal hernias are common among men, especially with aging. The lower risk among heavier men was unexpected and bears further study.

Risk Factors for Inguinal Hernia among Adults in the US Population

Einleitung. Die Narbenhernienentwicklung stellt eine der haufigsten operationspflichtigen Komplikationen in der Viszeralchirurgie dar. Die Risikofaktoren fur die Narbenhernienentstehung und Strategien zu ihrer Vermeidung sind umstritten. Methoden. In einer retrospektiven Untersuchung an 2.983 Patienten uber einen Zeitraum von 10 Jahren wurde der Einfluss demographischer Daten sowie von pra-, intra- und postoperativen Risikofaktoren auf die Narbenhernienentstehung untersucht. Aus den Untergruppen Vorerkrankungen, Medikation, Laborparameter, Indikation, Operationstechnik, Operationsverlauf, postoperativer Verlauf und Wundheilung wurden 43 Parameter untersucht. Die statistische Analyse erfolgte mit dem χ2-Test nach Pearson sowie multivariat mit der binar logistischen Regression. Ergebnisse. Die mittlere Narbenhernieninzidenz betrug 4,3%. Fur den durchschnittlichen Beobachtungszeitraum von 21,1 Monaten lag die nach Kaplan-Meier berechnete Narbenhernieninzidenz bei 9,8%, fur einen Zeitraum von 10 Jahren bei 18,7%. In den ersten 6 Monaten entstanden 31,5% der Narbenhernien, 54,3% der Narbenhernien manifestierten sich nach 1 Jahr, 74.8% nach 2 und 88,9% nach 5 Jahren. Als signifikante demographische Faktoren fur die Narbenhernieninzidenz fanden sich Lebensalter (>45 Jahre) und mannliches Geschlecht. Die praoperativen Faktoren Anamie (Hb 25), die intraoperativen Faktoren Rezidivinzision, Voroperationen sowie die postoperativen Faktoren Katecholamintherapie und Wundkomplikationen hatten ebenfalls signifikanten Einfluss bei der univariaten Analyse. Schlussfolgerung. Die zu erwartende Narbenhernieninzidenz von fast 20% bei langer Nachbeobachtungszeit sowie die Manifestation von 50% der Narbenhernien mehr als 1 Jahr postoperativ unterstreichen die Notwendigkeit, der Laparotomieheilung mehr Beachtung zu schenken. Hinter demographischen und endogenen Risikofaktoren treten operativ-technische Faktoren als Ausloser der Narbenhernienentstehung in den Hintergrund. Mit vertretbarem Aufwand scheinen Masnahmen zur Verbesserung der Gewebeperfusion geeignet, die Narbenhernieninzidenz zu beeinflussen.

Einflussfaktoren der Narbenhernienentstehung Retrospektive Untersuchung an 2.983 laparotomierten Patienten über einen Zeitraum von 10 Jahren

Publisher Summary This chapter discusses the interaction of lipids and lipoproteins with the intercellular matrix of arterial tissue and its' possible role in atherogenesis. It presents the multiple lines of evidence that suggest the relevance of the intima-medial extracellular matrix to the interactions of plasma lipoproteins with the arterial wall. Probably many of the phenomena involved in such interactions have evolved as efficient means by which the smooth muscle cells make metabolic use of lipoprotein components and by which membrane components are exchanged. The deposition and accumulation of lipoprotein components in the matrix that seem to stimulate the proliferative response associated with the initial atherogenic response are just the result of amplification and/or saturation of normal processes. Therefore, one should concentrate on demonstrating their occurrence in normal tissue and during the initial development of the atherosclerotic lesion. The complexity of the associations among cells, collagen, elastin, proteoglycans, glycoproteins, and lipoproteins indicates that to characterize them, one will need multiple approaches. Study of the in vitro physicochemical parameters as well as experiments conducted in vivo and with cells and tissues will be important.

The interaction of lipids and lipoproteins with the intercellular matrix of arterial tissue: its possible role in atherogenesis.

The surgical mesh-free repair of incisional hernias has to face recurrence rates of up to 50%. Apart from technical faults this is probably due to collagen metabolic disorders, known to play an import

Abnormal collagen I to III distribution in the skin of patients with incisional hernia.

Direct inguinal herniation in men: a disease of collagen.

1. 1. Fibroblastic cell cultures were derived from the anterior rectus sheath of one control patient, two men with indirect, and three with direct inguinal herniation. The rates of cell proliferation were studied up to thirty-nine days. The results obtained through regression equations indicated that the rate of cell proliferation is decreased among cells derived from patients with herniation as compared to that of a control. The order of decrease corresponded to the type of herniation. The average generation time was about one and a half times longer for cells obtained from herniated tissue as compared to that of normal cells. 2. 2. In vitro studies pertaining to the rates of incorporation of radioactively-labeled proline into the anterior rectus sheath of patients with and without herniation revealed that the incorporation of proline was significantly lower in the rectus sheath from patients with hernias as compared to that of normal tissue. The least incorporation was observed in direct herniation. 3. 3. From these observations it is suggested that the cause of herniation in the adult lies in a reduced collagen synthesis by the fibroblasts, thus rendering the abdominal aponeuroses weaker.

Defective collagen synthesis in inguinal herniation

SummaryChemical composition of rectus sheath from normal, and indirect and direct inguinal hernia patients has indicated that in inguinal hernia the rectus sheath contains decreased amount of collagen as compared to controls. Total hexose, uronic acid, and hexosamine were not significantly altered.

Premanand V. Wagh

Papers

Direct inguinal herniation in men: a disease of collagen.

Defective collagen synthesis in inguinal herniation

Collagen Deficiency in Rectus Sheath of Patients with Inguinal Herniation

Defective collagen synthesis in inguinal herniation

Purification and characterization of a glycoprotein from the intimal region of porcine aorta.