Special issue—Collagen

Abstract

Hernia is the most frequent surgical disease with an overall incidence of more than 10% of the total population and at least the same percentage of the average surgeon’s workload. Since its Wrst description more than 4,000 years ago by Babylonians and Egyptians, hernia has always been understood as a mechanical defect of the abdominal wall caused by trauma, heavy weight lifting, or maximum intraabdominal pressure. Because the etiology of hernia was suspected to be a mechanical problem, traditional surgery consisted of mechanical repair by suture, i.e. direct closure of the hernia defect by suturing. Although this repair usually succeeds, hernias recur at a rate of 10–15%, despite the best mechanical suture repair. At the beginning of the 20th century, understanding of hernia as a simple mechanical defect was questioned by some anatomists, who asked about the connective tissue and its role in hernia development. The Wrst systematic discussion of hernia as a disease of the connective tissue was that of Raymond Read in the 1960s, with many studies and papers on hernia as a result of weak collagen. Since these pioneering publications much evidence has accumulated suggesting hernia disease can no longer be regarded as a simple mechanical defect but must be understood as a connective tissue problem. The demographic development of our population furnishes evidence of an inverse correlation between mechanical activity and hernia incidence—the older the patients the higher is the incidence of hernia and the less the strength of the connective tissue. Surgeons from all over the world therefore agree that we must understand hernia as a connective tissue disorder that can be treated only in very few young patients by simple suture and must be handled in most patients by mesh augmentation. This understanding of collagen disease is the reason for the increased use of mesh in hernia surgery today; it will continue as long as we have no pharmaceutical method available to increase the strength of the weak collagen. It was Raymond Reads proposal to arrange a special supplement on collagen disease in the “Hernia” journal. Authors from diVerent groups worldwide have participated in this collection and present diVerent aspects of the collagen problem in hernia disease. One can see that since the Wrst discussions of hernia as a collagen disorder much evidence and knowledge has been accumulated, enabling slightly better understanding and treatment of this misunderstood “mechanical” problem. Because Raymond Read was the pioneer of this new understanding of hernia as a collagen disease, this volume is dedicated to this great researcher and surgeon, the nestor of modern hernia surgery.