The Unified Theory of hernia formation

Abstract

The perusal of surgical journals suggests that the etiology and the treatment of hernias are still based on the understanding of a simple mechanical defect, an idiopathic happenstance requiring a reliable hernia repair, preferably with a prosthetic mesh or device. The need for additional elucidation does not constitute an aim that is pervasive in the surgical community or with the corporate manufacturers of surgical implements. This may well be because surgeons are not trained scientists and laboratory workers. Fortunately, several disciplines are injecting a healthy dose of curiosity matched by ingenuity. Among these contributors, we can count anatomists, electron microscopists, biochemists, organic chemists, pathologists, geneticists, and molecular biologists, who have looked at collagen, enzymes, tobacco smoke, congenital diseases, and chromosomal defects. Every aspect of the researchers' work has identified and converged onto a final common organ: collagen. It is the pathological changes in collagen that set the stage for the development of a hernia. The multiple theories on mechanisms of hernia formation have, at last, melded into one single Unified Theory of hernia formation.

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia

“…If the prostheses really are related to these cases of infertility, the physiopathology has not yet been fully clarified. The protection given to the elements of the spermatic funiculus by the cremaster muscle has been cited as one advantage of the Lichtenstein procedure in relation to other techniques in which the prosthesis remains in contact with vessels and nerves 26 . This protection may be increased by using flaps of aponeurosis that are placed between the prosthesis and the funiculus.…”

“…Use of stem cells, cultivation of tissues in the laboratory, correction of errors in collagen synthesis and cell mediators, and supplying of enzymatic and biochemical deficiencies are directions to be taken up are the directions to be taken by those who are studying the surgical correction of hernias 27 . Bendavid 26 stated that in the future it is possible that hernias will be classified as diseases connected with metabolism errors and malnutrition 27 . Until then, it is prudent to state that the implantation of prostheses in young patients undergoing infertility treatment should be considered.…”

¿Existe Alteración de los Mecanismos de Degradación del Colágeno de la Matriz Extracelular Manifestada en la Expresión de MMP2 y TIMP2 en Pacientes con Hernia Inguinal Primaria?

“…Respecto a la patogenia de la HI, existen diversos reportes que la asocian a alteraciones a nivel de tejido conjuntivo y de la matriz colágena (Wagh et al, 1972;Friedman et al, 1993;Rosch et al, 2002;Bórquez et al, 2003;Bendavid, 2004). Posteriormente, han aparecido estudios que han establecido mayor expresión de tipos especí-ficos de metaloproteinasas, enzimas que degradan colágeno, en cultivos de fibroblastos de individuos portadores de HI (Bellón et al, 1997;Bellón et al, 2001); aunque se trata de artículos de tipo experimental sin una estimación del tamaño de la muestra y calidad metodológica inadecuada.…”

Case Report: Amyand’s Hernia

“…Apendiksin inguinal herni kesesi içinde bulunması ise Amyand herni olarak adlandırılmakta olup, ilk kez Claudius Amyand tarafından 1735 tarihinde 11 yaşındaki bir erkek çocuğunda herni kesesi içerisinde perfore bir apendiks varlığının bulunmasıyla tanımlanmıştır (1,2). Herniye olmuş apendiks normal olabileceği gibi, karın kaslarının kasılması sonucu batın içi basıncın artması ve kronik hernilerde oluşan yapışıklıklar apendiks mezosunu sıkıştırarak apendiksin kanlanmasını bozar ve bunun sonucunda iltihaplanmaya ve akut apandisit gelişimine yol açabilir (2,8,9).…”

“…Amyand herni erkeklerde daha sık görülmekte olup, amyand hernisi olan kadın hastalar postmenopozaldir ve genellikle femoral herni mevcuttur (8,10,11). İnguinal herni kesesinde normal bir apendiks varlığı tüm eksternal hernilerin %1'ini oluşturur (3).…”