Skip to main content

Advertisement

Log in

Collagen metabolism and recurrent hiatal hernia: cause and effect?

  • Review
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Hiatus hernia (HH) is a condition characterized by herniation of the intra-abdominal organs into the thorax. Of the several types that have been identified, the most common is type I (sliding) HH. Congenital predisposition and acquired factors, for example trauma and iatrogeny, have been identified as causative factors. There is a strong association between gastroesophageal reflux disease and HH—the prevalence of reflux in HH may reach 94%. Many methods have been used to treat reflux disease and HH, among which are laparoscopic techniques, which gained popularity as a safe method of treatment. Primary crural repair without mesh application was found to have a recurrence rate of up to 42%. This led to the introduction of mesh in HH repair, which was associated with a significant decrease in recurrence rate. Collagen and its relation to hernia have been investigated for several decades. Collagen has mechanical properties sufficient to enable it to support healed scars and other tissues. Nineteen distinct types of collagen have been recognized, the most common of which are types I and III. Type III collagen is the major constituent of early granulation tissue whereas type I predominates as healing proceeds. Collagen fibers are imbedded in extracellular matrix (ECM), which is in continuous process of synthesis and degradation under the action of matrix metalloproteinases. Many authors have studied the role of collagen in ventral hernia and have even defined hernia as a disease of the ECM. The relationship between collagen and HH, and its recurrence, is not fully understood and needs further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Skinner DB (1985) Hernias (hiatal, traumatic and congenital). In: Berk JE (ed) Gastroenterology, 4th edn. WB Saunders, Philadelphia, pp 706–716

    Google Scholar 

  2. Wright RA (1979) Relationship of hiatal hernia in endoscopically proved reflux esophagitis. Dig Dis Sci 24:311–313

    Article  PubMed  CAS  Google Scholar 

  3. Paterson WG, Kolyn DM (1994) Esophageal shortening induced by short-term intraluminal acid perfusion in opossum: a cause for hiatus hernia? Gastroenterology 107:1736–1740

    PubMed  CAS  Google Scholar 

  4. Tsugawa C, Kimura K, Nshijima E, Muraji T, Yamaguchi M (1997) Diaphragmatic eventration in infants and children: is conservative treatment justified? J Pediatr Surg 32(11):1643–1644

    Article  PubMed  CAS  Google Scholar 

  5. Flageole H (2003) Central hypoventilation and diaphragmatic eventration: diagnosis and management. Semin Pediatr Surg 12(1):38–45

    Article  PubMed  Google Scholar 

  6. Berstad A, Weberg R, Froyshow I et al (1986) Relationship of hiatus hernia to reflux esophagitis. A prospective study of coincidence, using endoscopy. Scan J Gastroenterol 21:55–58

    CAS  Google Scholar 

  7. Pertersen H, Johannesssen T, Sandvick AK et al (1991) Relationship between endoscopic hiatus hernia and gastroesophageal reflux symptoms. Scand J Gastroenterol 26:921–926

    Google Scholar 

  8. Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1991) Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 1:138–143

    PubMed  CAS  Google Scholar 

  9. Hinder RA, Filipi CJ, Wetscher G, Neary P, DeMeester TR, Perdikis G (1996) Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 220:472–483

    Article  Google Scholar 

  10. Weerts JM, Dallemagne B, Hamoir E, Demarche M, Markiewicz S, Jehas C, Lombard R, Demoulin JC, Etienne M, Ferron PE et al (1993) Laparoscopic Nissen fundoplication: detailed analysis of 132 patients. Surg Laparosc Endosc 3:359–363

    PubMed  CAS  Google Scholar 

  11. Athanasakis H, Tzortzinis A, Tsiaoussis J, Vassilakis JS, Xyones E (2001) Laparoscopic repair of paraesophageal hernia. Endoscopy 33:590–594

    Article  PubMed  CAS  Google Scholar 

  12. Hunter JG, Swanstorm L, Waring JP (1996) Dysphagia after laparoscopic antireflux surgery. The impact of operative technique. Ann Surg 224:51–57

    Article  PubMed  CAS  Google Scholar 

  13. McKernan JB, Champion JK (1995) Laparoscopic antireflux surgery. Am Surg 61:530–536

    PubMed  CAS  Google Scholar 

  14. Watson DI, Jamieson GG, Devitt PG, Mattew G, BrittenJones RE, Game PA, Williams RS (1995) Changing strategies in the performance of laparoscopic Nissen fundoplication as a result of experience with 230 operations. Surg Endosc 9:961–966

    PubMed  CAS  Google Scholar 

  15. Anvari M, Allen C (2003) Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg 196:51–59

    Article  PubMed  Google Scholar 

  16. Peters JH, DeMeester TR, Crookes P, Oberg S, de Vos Shoop M, Hagen JA, Bremner CG (1998) The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with “typical” symptoms. Ann Surg 228:40–50

    Article  PubMed  CAS  Google Scholar 

  17. Brammer T, Hinder RA, Klaus A, Klinger PJ (2001) Five- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg 5:42–48

    Article  Google Scholar 

  18. Lafullarde T, Watson DI, Jamieson GG, Meyers JC, Game PA, Devitt PG (2001) Laparoscopic Nissen fundoplication: five-year results and beyond. Arch Surg 136:180–184

    Article  PubMed  CAS  Google Scholar 

  19. Allen MS, Trastek VF, Deschamps C et al (1993) Intrathoracic stomach. Presentation and results of operation. J Thorac Cardiovasc Surg 105:253–259

    PubMed  CAS  Google Scholar 

  20. Luketich JD, Raja S, Fernando HC, Campell W, Christie NA, Buenaventura PO, Weigel TL, Keenan RJ, Schauer PR (2000) Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg 232:608–618

    Article  PubMed  CAS  Google Scholar 

  21. Williamson WA, Ellis FH Jr, Streitz JM Jr, Shahian DM (1993) Paraesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 56:447–451

    Article  PubMed  CAS  Google Scholar 

  22. Menguy R (1988) Surgical management of large paraesophageal hernia with complete intra thoracic stomach. World J Surg 12:415–422

    Article  PubMed  CAS  Google Scholar 

  23. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG (2000) Laparoscopic repair of large type III hiatal hernia: objective follow up reveals high recurrence rate. J Am Coll Surg 90:553–561

    Article  Google Scholar 

  24. Wiechmann RJ, Ferguson MK, Naunheim KS, Mc Kesey P, Hazelrigg SJ, Santucci TS, Machery RS, Landreneau RJ (2001) Laparoscopic management of giant paraesophageal herniation. Ann Thorac Surg 71:1080–1087

    Article  PubMed  CAS  Google Scholar 

  25. Johnson JM, Carbonell AM, Carmody BJ, Jamal MK, Maher JW, Kellum JM, DeMaria EJ (2006) Laparoscopic mesh hernioplasty for paraesophageal hernias and fundoplications. A critical analysis of available literature. Surg Endosc 20:362–366

    Article  PubMed  CAS  Google Scholar 

  26. Basso N, De Leo A, Rosato P, Rea S, Spaziani E, Primvera A (2000) 360 laparoscopic fundoplication with tension-free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease. Surg Endosc 14:164–169

    Article  PubMed  CAS  Google Scholar 

  27. Basso N, Rosato P, De Leo A, Genco A, Rea S, Neri Y (1999) “Tension-free” hiatoplasty, gastrophrenic anchorage, and 360 fundoplication in the laparoscopic treatment of paraesophageal hernia. Surg Laparosc Endosc 9:257–262

    Article  CAS  Google Scholar 

  28. Champion JK, Rock D (2003) Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 17:551–553

    Article  PubMed  CAS  Google Scholar 

  29. Hawasli A, Zonca S (1998) Laparoscopic repair of paraesophageal hiatal hernia. Am Surg 64:703–710

    PubMed  CAS  Google Scholar 

  30. Oelschlager BK, Barreca M, Chang L, Pellegrini CA (2003) The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique. Am J Surg 186:4–8

    Article  PubMed  Google Scholar 

  31. Carlson MA, Condon RE, Ludwig KA, Schulte WJ (1998) Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 187:227–230

    Article  PubMed  CAS  Google Scholar 

  32. Granderath FA, Carlson MA, Champion JK, Scold A, Basso N, Pointer R, Frantzides CT (2006) Prosthetic closure of the esophagus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc 20:367–379

    Article  PubMed  CAS  Google Scholar 

  33. Carlson MA, Richards CG, Frantzides CT (1999) Laparoscopic prosthetic reinforcement of hiatal hernioplasty. Dig Surg 16:359–363

    Article  Google Scholar 

  34. Casaccia M, Torelli P, Panaro F, Cavaliere D, Ventura A, Valente U (2002) Laparoscopic physiological hiatoplasty for hiatal hernia: new composite “A”- shaped mesh. Physical and geometrical analysis and preliminary clinical results. Surg Endosc 16:1441–1445

    Article  PubMed  CAS  Google Scholar 

  35. Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP (2002) A prospective, randomized trial of laparoscopic polytetrafluroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137:649–652

    Article  PubMed  Google Scholar 

  36. Granderath FA, Kamolz T, Schweiger UM, Pointer R (2003) Laparoscopic refundoplication with prosthetic hiatal hernia closure for recurrent hiatal hernia after primary failed antireflux surgery. Arch Surg 138:902–907

    Article  PubMed  Google Scholar 

  37. Keidar A, Szold A (2003) Laparoscopic repair of paraesophageal hernia with selective use of mesh. Surg Laparosc Endosc Percutan Tech 13:149–154

    Article  PubMed  Google Scholar 

  38. Kuster GG, Gilroy S (1993) Laparoscopic technique for repair of paraesophageal hiatal hernias. J Laparoendosc Surg 3:331–338

    PubMed  CAS  Google Scholar 

  39. Huntington TR (1997) Laparoscopic mesh repair of the esophageal hiatus. J Am Coll Surg 184:399–401

    PubMed  CAS  Google Scholar 

  40. Paul MG, DeRosa RP, Petrucci PE, Palmer ML, Danovich SH (1997) Laparoscopic tension free repair of large paraesophageal hernias. Surg Endosc 11:303–307

    Article  PubMed  CAS  Google Scholar 

  41. Baladas HG, Smith GS, Richardson MA, Dempsey MB, Falk GL (2000) Esophagogastric fistula secondary to Teflon pledget: a rare complication following laparoscopic fundoplication. Dis Esophagus 13:72–74

    Article  PubMed  CAS  Google Scholar 

  42. Dally E, Falt GL (2004) Teflon pledget reinforcement fundoplication causes symptomatic gastric and esophageal luminal penetration. Am J Surg 187:226–229

    Article  PubMed  Google Scholar 

  43. Florez DA, Howington JA, Long JD (2003) Esophageal obstruction secondary to erosion of Angelchik prosthesis: the role of endoscopic management. Gastrointest endosc 58:624–626

    PubMed  Google Scholar 

  44. Varshney S, Kelly JJ, Branagan G, Somers SS, Kelly JM (2002) Angelchik prosthesis revisited. World J Surg 26:129–133

    Article  PubMed  Google Scholar 

  45. Casabella F, Sinanan M, Horgan S, Pellegrini CA (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 171:485–489

    Article  PubMed  CAS  Google Scholar 

  46. Coluccio G, Ponzio S, Ambu V, Tramontano R, Cuomo G (2000) Dislocation into the cardial lumen of PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia, a case report. Minerva Chir 55:341–345

    PubMed  CAS  Google Scholar 

  47. Frantzides CT, Richards CG, Carlson MA (1999) Laparoscopic repair of large hiatal hernia with polytetrafluroethylene. Surg Endosc 13:906–908

    Article  PubMed  CAS  Google Scholar 

  48. Perdikis G, Hinder RA, Filipi CJ, Walenz T, McBride PJ, Smith SL, Katada N, Klingler PG (1997) Laparoscopic paraesophageal hernia repair. Arch Surg 132(6):586–589

    PubMed  CAS  Google Scholar 

  49. Schauer PR, Ikramuddin S, McLaughlin RH, Graham TO, Slivka A, Lee KK, Schraut WH, Lukertich JD 1998 Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg 176(6):659–665

    Article  PubMed  CAS  Google Scholar 

  50. Watson DI, Davies N, Devitt PG, Jamieson GG (1999) Importance of dissection of the hernial sac in laparoscopic surgery for large paraesophageal hiatal hernia. Arch Surg 134:1069–1073

    Article  PubMed  CAS  Google Scholar 

  51. Iqbal A, Kakarlapudi GV, Awad ZT, Haynatzki G, Turaga KK, Anouki K, Fritz K, Haider M, Mittal SK, Filipi CJ (2006) Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic Nissen fundoplication. J Gastrointest Surg 10(1):12–21

    Article  PubMed  Google Scholar 

  52. Orringer MB, Skinner DB, Belsey RH (1973) Long-term results of the Mark IV operation for hiatal hernia and analysis of recurrences and their treatment. J Thorac Cardiovasc Surg 63:25–31

    Google Scholar 

  53. Read RC (1998) Cigarette smoking, herniation and recurrence. Surgery 124(5):942

    PubMed  CAS  Google Scholar 

  54. Jorgensen LN, Kallehave F, Christensen E, Siana JE, Gottrup F (1998) Less collagen production in smokers. Surgery 124(4):450–455

    Google Scholar 

  55. Holmdahl L, Al-Jabreen M, Risberg B (1994) Experimental models for quantitative studies on adhesion formation in rats and rabbits. Eur Surg Res 26(4):248–256

    PubMed  CAS  Google Scholar 

  56. Forrester JC (1995) Wounds and their management: wound biochemistry. In: Cuschieri A, Giles GR, Moosa AR (eds) Essential surgical practice, 3rd edn. Butterworth-Heinemann, Oxford, pp 179–181

    Google Scholar 

  57. Si Z, Rhanjit B, Rosch R, Rene PM, Klosterhalfen B, Klinge U (2002) Impaired balance of type I and type III procollagen mRNA in cultured fibroblasts of patients with incisional hernia. Surgery 131:324–331

    Article  PubMed  Google Scholar 

  58. Jansen PL, Merens PR, Klinge U, Schumpelick V (2004) The biology of hernia formation. Surgery 136(1):1–4

    Article  PubMed  Google Scholar 

  59. Bellon JM, Bajo A, Ga-Honduvilla N, Gimeno MJ, Pascual G, Guerroro A, Bujan J (2001) Fibroblasts from the transversalis fascia of young patients with direct inguinal hernias show constitutive MMP-2 overexpression. Am Surg 233:287–291

    CAS  Google Scholar 

  60. Zheng H, Si Z, Kasperk R, Bhardwaj RS, Schumpelick V, Klinge U, Klosterhalfen B (2002) Recurrent inguinal hernia: disease of collagen matrix? World J Surg 26:401–408

    Article  PubMed  Google Scholar 

  61. Klinge U, Junge K, Mertens PR (2004) Herniosis: a biological approach. Hernia 8(4):296–299

    Article  Google Scholar 

  62. Wagh PV, Leverich AP, Sun CN, White HJ, Read RC (1974) Direct inguinal herniation in men: a disease of collagen. J Surg Res 17(6):425–433

    Article  PubMed  CAS  Google Scholar 

  63. Klinge U, Si Z, Zheng H, Schumpelick V (2001) Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg 14(1):47–54

    Article  PubMed  CAS  Google Scholar 

  64. Rosch R, Junge K, Knops M, Lynen P, Klinge U, Schumpelick V (2003) Analysis of collagen-interacting proteins in patients with incisional hernias. Langenbecks Arch Surg 387(11–12):427–432

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We are thankful for Mr David Goodsell for permitting us to use Figures 2 and 4 in our article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Charles J. Filipi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El Sherif, A., Yano, F., Mittal, S. et al. Collagen metabolism and recurrent hiatal hernia: cause and effect?. Hernia 10, 511–520 (2006). https://doi.org/10.1007/s10029-006-0152-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-006-0152-9

Keywords

Navigation