title: Connective tissue alteration in abdominal wall hernia.
abstract: BACKGROUND
  The aetiology and pathogenesis of abdominal wall hernia formation is complex. Optimal treatment of hernias depends on a full understanding of the pathophysiological mechanisms involved in their formation. The aim of this study was to review the literature on specific collagen alterations in abdominal wall hernia formation.
  
  
  METHODS
  A computer-assisted search of the medical databases PubMed and Embase was performed, together with a cross-reference search of eligible papers.
  
  
  RESULTS
  Fifty-two papers were included. Collagen alteration depended on the type of hernia; there were more pronounced changes in patients with a direct inguinal hernia than in those with an indirect inguinal hernia, recurrent inguinal hernia or incisional hernia. A consistent finding was a significant increase in immature type III collagen relative to the stronger type I collagen in patients with a hernia. This resulted in thinner collagen fibres with a correspondingly diminished biomechanical strength. It has been suggested that these alterations are due to variation in the synthesis, maturation or degradation of collagen by matrix metalloproteinases, in combination or alone.
  
  
  CONCLUSIONS
  Hernia formation and recurrence is associated with altered collagen metabolism manifested by a decreased type I:III collagen ratio.
authors.affiliation: Department of Surgery K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: N A
authors.initials: NA
authors.lastname: Henriksen
authors.forename: D H
authors.initials: DH
authors.lastname: Yadete
authors.forename: L T
authors.initials: LT
authors.lastname: Sorensen
authors.forename: M S
authors.initials: MS
authors.lastname: Agren
authors.forename: L N
authors.initials: LN
authors.lastname: Jorgensen
mesh_terms: D034861:Abdominal Wall; D024042:Collagen Type I / Q000378:metabolism* / Q000648:ultrastructure; D024061:Collagen Type III / Q000378:metabolism* / Q000648:ultrastructure; D003238:Connective Tissue / Q000378:metabolism* / Q000648:ultrastructure; D016326:Extracellular Matrix Proteins / Q000378:metabolism; D046449:Hernia, Abdominal / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D020782:Matrix Metalloproteinases / Q000502:physiology; D008854:Microscopy, Electron; D012008:Recurrence
chemical_list: D024042:Collagen Type I; D024061:Collagen Type III; D016326:Extracellular Matrix Proteins; D020782:Matrix Metalloproteinases