A Connective Tissue Disorder
NATIONAL CENTER OF EXCELLENCE
From The NORTH PENN HERNIA INSTITUTE
LEADER IN ADVANCED HERNIA SURGERY
Many Hernia specialists, including the surgeons of the North Penn Hernia Institute, strongly believe that there is a true Connective Tissue Disorder (CTD) in a cadre of patients with hernias, and including many, if not most patients with troubling recurrent hernias. Such patients have various identifiable abnormalities at a cellular and biological level. The connective tissue that they generate (fascia, tendon, ligament and scar tissue) all come from essentially the same cell of origin; the Fibroblast.
Electron Micrograph of Normal FIBROBLAST
But in these patients the tensile strength and integrity of the connective tissue is defective; weaker to some extent. It contains a lower level of Type III collagen, the substance that imparts that strength to connective tissue. Moreover, these patients have a higher level of circulating elastase and protease in their blood; substances that break down connective tissue of all types. Thus, they are not only creating abnormal connective tissue and scarring (read -"defective healing"), but once it is made, it is broken down at a faster rate, replaced yet again by abnormal connective tissue.
All of the pieces of this complex puzzle are not yet discovered, but more and more research evidence is leading to the conclusion that perhaps "hernia" is not just a local condition, but perhaps a systemic disease (Herniosis) predisposing patients to hernia development and recurrent hernias. Unfortunately, a "diagnostic test" for this suspected condition has yet to be identified, and many more pieces of the puzzle need to be identified for a true cause and effect basis for the diagnosis of Herniosis to be confirmed as a reality.
This CTD affects not only their host connective tissue, but also ones' ability to heal by normal scaring. As tension also affects healing additively, these patients are the ones prone to hernia recurrence with non-mesh, tissue-based suture only repairs. This forms the basis for the use of mesh in hernia repairs. While it does not change the abnormal connective tissue present, nor it's rapid turnover, the mesh remains as a permanent lattice or bridge, reinforcing the hernia defect (and if properly performed, the entire hernia prone defect such as the Myopectineal Orifice of the inguinal area.
At NPHI, we believe that biological meshes, because they absorb, dissolve or to an extent deteriorate do not provide to consistent reinforcement needed indefinitely in these patients. Thus we are advocates for the safe and effective use of permanent, light-weight mesh products for primary and recurrent hernia repairs, and reserve the use of biological mesh products for contaminated or infected operative fields.