Are collagens the culprits in the development of incisional and inguinal hernia disease?

Incidence curves for the development of inguinal hernia disease and recurrences thereof exhibit a linear rise over the years and therefore suggest multi-factorial underlying causes. Several studies have revealed marked changes in the abundance and composition of interstitial collagens in patients with (recurrent) hernia diseases, adult groin hernia and incisional hernia. These observations led to the hypothesis that hernia formation and the recurrence of incisional hernia may be explained by disordered tissue renewal and by abnormal wound healing, respectively. Interstitial collagens, owing to their long half-lives and biomechanical strength, are most likely critical components of the biological system of tissue remodelling. An overview of the literature is provided, and the consequences for surgical practice are discussed.