Hernias- Is it a primary defect or a systemic disorder? Role of collagen III in all hernias- A case control study

Abstract

IntroductionThe need of this study is to assess the role of collagen III in all hernias which include primary inguinal hernias ventral and recurrent abdominal hernias.Collagen type III represents the mechanically instable, less cross-linked collagen synthesized during the early days of wound healing. Quantitative assessment of collagen III in scar tissue on transversalis fascia as tissue obtained from cases operated for various hernias and compared to that of patients operated for abdominal surgeries for indications other than hernia was compared.Materials and methodsIn this study we had a total of 90 patients, of which 45 patients underwent mesh repair for the various hernias and 45 patients who underwent laparotomies for various reasons were included as controls. Size of 1 × 1cm transversalis fascia was taken in both subjects and was sent for quantitative assessment using Immunohistochemistry test. All the above cases were randomized as per age,sex,BMI, co morbidities and materials used for repair.ResultsResults were analysed quantitatively and classified into following groups:Based on intensity of staining into Mild, Intermediate and Well stained and based on Quantity of Collagen III into Grade 0---NIL, Grade 1--1-25%, Grade 2-26-50%, Grade 3--51-75%, Grade 4--76-100% (Table 1). In the case group we had 52.4%,35.7% and 11.9% of the cases in Grade 4, Grade 3 and Grade 2 which proved that there was increased presence of Collagen 3, where as 84.4%,4.4% and 11.1% of patients in the control group were classified as Grade 1, Grade 2, Grade 0. For the quantitative study -Chi square test value −81.279 and the p value < 0.001. For the intensity of staining -Chi square test value −57.64 and p value is < 0.001.ConclusionThis study signifies that ventral, recurrent and primary inguinal hernias are not just caused because of a primary defect but an acquired disorder with respect to collagen distribution.

Molecular Mechanisms and Potential Therapeutic Targets in Incisional Hernia

“…The intermolecular cross-linking between collagen type I and type III imparts additional strength to the abdominal wall tissue 14 . Interestingly, a drastic decrease in the ratio of collagen type I to type III results in a disorganized ECM in tissues from IH patients 15,16 . However, the molecular mechanisms causing the alteration of collagen type I to type III ratio, and the associated fibroblast biology and their regulatory roles in driving IH development warrant further investigation.…”

The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia

“…According to the clinical indications and types of hernia, a parastomal hernia should be treated as a special case of incisional hernia. The development of a hernia is the result of alternations within the structure of the connective tissue, including a problem with collagen synthesis [ 15 , 16 , 17 ].…”

Family History of GERD Does Not Predict Anti-Reflux Surgery Outcomes

“… 18 What used to be postulated because of prior surgery or weakness in abdominal tissue has now been shown to be directly related to a genetic predisposition of increased type III collagen thus making the overall muscle weaker. 19 Due to the retrospective design of this study, the data available did not allow for us to investigate a potential genetic predisposition based on genetic markers. Future studies which collect such data regarding the genetic make-up of GERD patients and may be beneficial to better define the role of family history in the development of GERD and need for ARS.…”