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Journal ArticleDOI

Direct inguinal herniation in men: a disease of collagen.

01 Dec 1974-Journal of Surgical Research (J Surg Res)-Vol. 17, Iss: 6, pp 425-433
About: This article is published in Journal of Surgical Research.The article was published on 1974-12-01. It has received 149 citations till now. The article focuses on the topics: Hernia.
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Journal ArticleDOI
13 Feb 2014-Chirurg
TL;DR: The calculated incisional hernia incidence for a 10 year period of almost 20% and the manifestation of 50% of all hernias more than 12 months after the operation, underline the necessity to intensify surgical research in the field of laparotomy healing.
Abstract: 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.

257 citations

Journal ArticleDOI
01 Jul 2004-Surgery
TL;DR: Increased collagen breakdown mediated by matrix metalloproteinase-2 (MMP-2) is suggested to be involved in inguinal hernia formation and published data point towards hernia disease as an inherited disease.

189 citations

Journal ArticleDOI
TL;DR: The results give evidence of the existence of a possible collagen disorder in patients with incisional hernias and recurrent incisions, which might explain the poor results of a mesh-free hernia repair, which builds up scar tissue of inadequate collagen composition and strength.
Abstract: The late appearance of incisional hernias several years after laparotomy and the high recurrence rates after operation strongly imply the presence of a disorder of the connective tissue, although a specific defect in patients with incisional hernias has not yet been identified. In the present study we used both immunohistochemistry and Western blot analysis to evaluate the ratio of collagen I and III and the expression of the metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional or recurrent incisional hernias. Samples of healthy skin or stable skin scar in patients without hernias served as controls. Altogether, our data indicated a significantly decreased ratio of collagen I/III in the fascia of patients with incisional hernias and recurrent incisional hernias. Furthermore, in these patients the expression of MMP-1 was decreased compared to the controls, whereas MMP-13 could not be detected in any fascia sample, with or without hernias present. For the first time, our results give ...

160 citations

Journal ArticleDOI
TL;DR: The authors review the literature emphasizing the current knowledge concerning the pathogenesis of incisional hernias, and focuses on the treatment.
Abstract: Incisional hernias represent one of the most frequent complications of abdominal surgery. The incidence is probably underestimated. The pathogenesis is complex and not fully understood, implying patient-related factors (i.e., collagen biochemistry, obesity, age) as well as technical factors, including, among others, wound infection, suture material, and types of incisions and closures. In this paper, the first of two, the authors review the literature emphasizing the current knowledge concerning the pathogenesis of incisional hernias. The second article is focused on the treatment.

160 citations

References
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Journal ArticleDOI
TL;DR: Method has been applied to a study of hydroxyproline distribution in cell particulates, tissue fluids, and purified plant and animal proteins, and significant amounts of hydroXYproline were found in crystalline preparations of pepsin, elastase.

3,756 citations

Journal ArticleDOI
TL;DR: 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.
Abstract: 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.

97 citations

Journal ArticleDOI
TL;DR: It is suggested that metal ions play a part in the interaction of collagen fibrils and the interfibrillar matrix in tendon, indicating the chemical purity of the collagen.

88 citations

Journal ArticleDOI
TL;DR: Results indicate that in inguinal herniation the rectus sheath unrelated to the defect is thinner than normal, and a patent processus vaginalis allows herniated with less atrophy than in direct defects.
Abstract: Summary During the preperitoneal approach to groin hernias in the adult, the abdominal aponeuroses but not the musculature appeared thinner than normal. This impression was investigated by weighing samples of constant area. A disk of rectus sheath just lateral to the linea alba, one fingerbreadth below the anterior superior iliac spine, was trephined in a series of hernias along with "controls." Mean wet weight (gm) in these fifty-four control patients operated on for abdominal disease, whose average age was 56.9 years, was 0.174 ± 0.34 (SD). This differed significantly (p value .01 and .001) from both that of 0.164 ± .036 obtained in 188 veterans (average age 54.9) with indirect herniation, and a mean of 0.138 ± .031 found in 134 men (average age 55.8) having direct hernias. Thirty-four patients with mixed hernias either unilateral (pantaloon) or bilateral had intermediate results. In each hernial type, patients with bilateral defects had "lighter" aponeuroses compared to those with unilateral defects. Water content (64 to 74 per cent) was comparable. Surprisingly, biopsy weight did not relate to age (nineteen to ninety-five years) or muscle mass. These results indicate that in inguinal herniation the rectus sheath unrelated to the defect is thinner than normal. A patent processus vaginalis allows herniation with less atrophy than in direct defects. Presenile aponeurotic atrophy, whose etiology is unknown, explains the development and recurrence rate of inguinal herniation in the adult. Biochemical studies are underway to characterize the nature of the fascial deficiency which may be a form of premature aging.

80 citations