Collagenopathies—Implications for Abdominal Wall Reconstruction: A Systematic Review

Abstract

Background:The etiology of hernia formation is strongly debated and includes mechanical strain, prior surgical intervention, abnormal embryologic development, and increased intraabdominal pressure. Although the most common inciting cause in ventral hernias is previous abdominal surgery, many other factors contribute. We explore this etiology through an examination of the current literature and existing evidence on patients with collagen vascular diseases, such as Ehlers–Danlos syndrome.Methods:A systematic review of the published literature was performed of all available Spanish and English language PubMed and Cochrane articles containing the key words “collagenopathies,” “collagenopathy,” “Ehlers-Danlos,” “ventral hernia,” and “hernia.”Results:Three hundred fifty-two articles were identified in the preliminary search. After review, 61 articles were included in the final review.Conclusions:Multiple authors suggest a qualitative or quantitative defect in collagen formation as a common factor in hernia formation. High-level clinical data clearly linking collagenopathies and hernia formation are lacking. However, a trend in pathologic studies suggests a link between abnormal collagen production and/or processing that is likely associated with hernia development.

Hypermobile Ehlers–Danlos syndrome (a.k.a. Ehlers–Danlos syndrome Type III and Ehlers–Danlos syndrome hypermobility type): Clinical description and natural history

“…Morphological findings with a presumed higher rate in hEDS compared to the general population may include abdominal hernias, rectal prolapse, ptosis of internal organs, diaphragmatic hernias, and intestinal intussusceptions. Systematic data are available for abdominal hernias [Harrison et al, ] and rectal prolapse [Manning et al, ] only, while all other features are described in single reports only and their relationship with hEDS remains to be further scrutinized. Abdominal hernias occur in up to one‐fifth of the patients; the chance of occurrence increases with age, and their surgical treatment seems effective under standard procedures [Harrison et al, ].…”

“…Systematic data are available for abdominal hernias [Harrison et al, ] and rectal prolapse [Manning et al, ] only, while all other features are described in single reports only and their relationship with hEDS remains to be further scrutinized. Abdominal hernias occur in up to one‐fifth of the patients; the chance of occurrence increases with age, and their surgical treatment seems effective under standard procedures [Harrison et al, ]. Rectal prolapse is observed in more than one tenth of women [Mastoroudes et al, ].…”

Nárakviðslit - Yfirlitsgrein

“…Þrátt fyrir að meingerð miðlaegra og hliðlaegra nárakviðslita sé ólík er orsökin í báðum tilvikum rakin til veikleika í bandvef kviðveggjarins, nánar tiltekið í byggingu kollagens. 17 Krufningarannsóknir á 8. áratugnum sýndu að þótt 20% karla séu með opinn slíðurklakk (vaginal process) fram á fullorðinsár greinist innan við helmingur þeirra með hliðlaegt kviðslit síðar á aevinni. 15 Til þess að slíðurklakkurinn lokist á fyrstu aeviárunum verða sléttar vöðvafrumur í honum að fá boð um frumudauða, en gerist það ekki, til daemis vegna skorts á örvun frá sefkerfi (parasympathetic), getur hann haldist opinn áfram.…”

“…Kviðslit eru mjög algeng hjá sjúklingum með aettgenga bandvefssjúkdóma eins og í heilkennum Marfans (allt að 32%) og Ehlers-Danlos (allt að 25%). 17 Nánustu aettingar sjúklinga sem greinst hafa með kviðslit eru einnig í aukinni áhaettu á að fá kviðslit sem bendir til að erfðagalli sé að hluta til orsakavaldur. Nýleg rannsókn sýndi að stökkbreytingar í fjórum genum, sem hafa með kollagensamsetningu og -niðurbrot að gera, voru algengari í sýnum frá sjúklingum með nárakviðslit.…”

Prevention of Complications of Incisional Hernia Repair: Current Problem State (Review)

“…A biological factor is of primary importance, which means connective tissue metabolic imbalance. Compared to normal patients, those with hernias are found to have collagen I and III ratio reduction in transverse fascia, aponeurosis, and the anterior abdominal wall skin, as well as an increased level of collagen matrix metalloproteinases [4,5]. The second group factors involve the errors in selecting suture materials and a technique to close laparotomy wounds, as well as surgeon's insufficient experience [6,7].…”