Pathogenesis (development of disease)
In incisional hernia, the hernial orifice is formed by a scar that passes through all layers of the abdominal wall. Under stress, this diverges due to its lack of elasticity.
Cicatricial hernia is the most common late complication of previous abdominal surgery. Approximately 20% of all abdominal surgery patients develop an incisional hernia, half of them within the first year after surgery.
Impaired collagen metabolism – significantly decreased collagen type I/III compared to normal fascia – appears to have a negative impact on tissue stability and scarring. Type 1 collagen is responsible for mechanical tissue resilience. The mechanically unstable type 3 collagen, which is formed primarily during the early wound healing phase, is later replaced by type 1 collagen as part of the organization process. Wound healing disorders also increase the risk for incisional hernia.
Another pathophysiologic factor is intra-abdominal (“inside the abdomen”) pressure spikes (eg, due to chronic cough, chronic constipation/obstruction).
Etiology (causes)
Biographic causes
- Hereditary (inherited) collagen disorders:
- Ehlers-Danlos syndrome – group of genetic connective tissue disorders characterized by increased elasticity of the skin and unusual tearability of the same.
- Osteogenesis imperfecta (OI) – disease of connective tissue characterized by incomplete bone formation with increased bone fragility.
- Cutis laxa (Cutis laxa syndrome) – hereditary congenital or acquired disease of connective tissue with wrinkled, sagging and flabby inelastic skin.
- Gender – male gender?
- Age > 45 years
Behavioral causes
- Consumption of stimulants
- Tobacco (smoking)
- Physical activity
- Heavy physical work
- Underweight (reduced nutritional and general condition).
- Overweight (BMI ≥ 25; obesity).
Disease-related causes
- Ascites* (abdominal dropsy).
- Chronic cough – e.g. due to bronchial asthma, chronic obstructive pulmonary disease (COPD).
- Chronic constipation* (constipation).
- Trauma (injury)
- Tumors in the abdomen*
* Well, increase in intra-abdominal pressure.
Medication (disruption of wound healing)
- ACE inhibitors (ACE inhibitors).
- Hormones
- Glucocorticoids (alclometasone, budenonside, dexamethasone, fluticasone, halometasone, hydrocortisone, mometasone, prednicarbate, prednisolone, triamcinolone).
- Immunosuppressants
- Non-steroidal anti-inflammatory drugs (NSAID).
- Cytostatic drugs
Operations
- Abdominal surgery/abdominal surgery (laparotomy/laparoscopies).
Other causes
- Weakness of connective tissue
- Pregnancy
