Abstract

Abstract Background The aim of this study was to determine the temporal evolution of extracellular matrix (ECM) remodelling and collagen biomarkers and their influence on incisional hernia recurrence after the IPOM plus repair. Methods A sub-cohort of patients (n=25) undergoing laparoscopic incisional hernia repair within the TACKoMesh randomised controlled trial were bled at serial timepoints up to 1-year following surgery. Serum/plasma concentration of biomarkers (Procollagen I, Procollagen III, Fibronectin, TGF-beta, MMP-2, MMP-9, TIMP-1, and TIMP-2) were quantified using ELISA and Luminex multiplex techniques. Data were described and compared between groups that developed and remained free from recurrence using R statistical software. Results Procollagen I was reduced relative to baseline on post-op Day 1 but increased at Days 6 and 30 (p<0.05). Procollagen III showed an elevation at Day 30. Lower levels of Procollagen I were detected at Day 0, Day 1 and Day 6 (p<0.05) and higher levels of Procollagen III at Day 0, Day 1, Day 6 and Day 30 (p<0.05) in patients with a recurrence. Fibronectin was reduced at Day 1 and 6 (p<0.05) whilst TGF-β was increased at Day 30 (p<0.05). MMP-2 and its inhibitor TIMP-2 were reduced at post-operative Day 1 (p<0.05). MMP-9 was persistently higher than baseline (p<0.05) at all timepoints. TIMP-1 was elevated at post-op Days 6 and 30. No differences were found in the circulating concentrations of these biomarkers to predict a recurrence. Conclusion In patients that developed incisional hernia recurrence, low levels of Procollagen I and high levels of Procollagen III were detected.

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