Surgical treatment of abdominal wall hernia has been based for many decades on observational evidence, as the disease physiopathology was ambiguous. The long-standing hypothesis of abnormal collagen metabolism as a causative factor of hernia disease seems to become substantiated by modern investigations, demonstrating a link between abnormal matrix metalloproteinase (MMP) expression and abdominal wall hernia. Current evidence suggests a strong correlation between MMP-2 and direct inguinal hernia, while the role of this MMP in indirect, incisional and recurrent hernias has not been completely elucidated yet. Furthermore, MMP-1 and MMP-13 seem to be implicated in the physiopathology of recurrent hernia, while limited data link MMP-1 also with incisional hernia formation. Despite the importance of MMP-9 in wound healing mechanisms, its role in hernia pathogenesis has not been adequately investigated. Future research is expected to decipher the complex physiopathological mechanisms of hernia development and provide a basis for potential therapeutic applications.
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Antoniou et al. (2009) studied this question.