Journal of Minimal Access Surgery

SYMPOSIUM
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Year : 2006  |  Volume : 2  |  Issue : 3  |  Page : 151--154

Hernia recurrence as a problem of biology and collagen

Uwe Klinge1, Marcel Binnebosel1, Raphael Rosch1, Peter Mertens2 
1 Department of Surgery, University Hospital of the RWTH Aachen, Aachen, Germany
2 Department of Nephrology and Clinical Immunology, University Hospital of the RWTH Aachen, Aachen, Germany

Correspondence Address:
Uwe Klinge
Department of Surgery, University Hospital of the RWTH Aachen, Pauwelsstraße 30, 52074 Aachen
Germany

Usually an abdominal wall hernia is regarded as a mechanical problem with a local defect which has to be closed by technical means. Despite the introduction of several therapeutic improvements, recurrent hernias still appear in 10-15%. Therefore, reasons for a recurrence are discussed in a more fundamental way. It is assumed that a failure mainly depends on the quality of the repair. Correspondingly, in principle, the close causal relationship between the technical component and its failure during time is reflected by an s-shaped outcome curve. In contrast, the configuration of the outcome curve changes markedly if a breakdown is caused by numerous components. Then, the superposition of all incidence curves inevitably leads to a linear decline of the outcome curve without any s-shaped deformation. Regarding outcome curves after hernia repair, the cumulative incidences for recurrences of both incisional and inguinal hernia show a linear rise over years. Considering the configuration of outcome curves of patients with hernia disease, it may therefore be insufficient to explain a recurrence just by a failing technical repair. Rather, biological reasons should be suspected, such as a defective wound healing with impaired scarring process. Recent molecular-biological findings provide increasing evidence of underlying biochemical alterations in patients with recurrent hernia. Until predicting markers to identify patients with an impaired wound healing are available and considering the formation of insufficient scar as the underlying disease, the consequences for every surgical repair should be a supplementary reinforcement with nonabsorbable alloplastic nets as flat meshes with an extensive overlap.


How to cite this article:
Klinge U, Binnebosel M, Rosch R, Mertens P. Hernia recurrence as a problem of biology and collagen.J Min Access Surg 2006;2:151-154


How to cite this URL:
Klinge U, Binnebosel M, Rosch R, Mertens P. Hernia recurrence as a problem of biology and collagen. J Min Access Surg [serial online] 2006 [cited 2019 Aug 21 ];2:151-154
Available from: http://www.journalofmas.com/article.asp?issn=0972-9941;year=2006;volume=2;issue=3;spage=151;epage=154;aulast=Klinge;type=0