Page 21 - herina surgery and possible lawsuits

Pans concluded that some "molecular alteration in collagen may be involved in the
genesis of groin hemias."Why this defect appears preferentially in the inguinal region
remains a mystery.[50]

3. Cigarette smoking leads to proteolysis by evoking a neutrophil and macrophage response,
release of elastase and collagenase, destroys the lung parenchyma. Further, oxidants
produced from combustion of tobacco damage antiprotease defences. Circulating

enzymes may lead similar changes cause peripheral collagenolysis and causes hernia.
Similar changes are also seen m patients of aneurysm. [47,48]
4. Genetic influence in groin hernia is documented by familial tendency with autosomal

dominant with incomplete penetrance of a preferential paternal factor.
A higher prevalence of inguinal hernia is well known among patients suffering
from congenital connective tissue disorders like osteogenesis imperfecta, cutis laxa,

and Marfan's syndromes. In children with congenital hip dislocation, inguinal hernia
occurs five times more often in girls and three times more often in boys compared to
children without this disease. [48]

5. Spontaneous or iatrogenic trauma of the abdominal wall cause inguinal hernia.
Previous appendectomy with cosmetic unilateral pfannenstiel approach may causes of
damage to the iliohypogastric nerve and may be the cause of groin henna.
6. Physical exertion histoncally believed to be the etiology of groin herniation and

workmen compensation, but now more and more evidence accumulated that casts
doubt on the legal foundation for such compensation. Weightlifters do not have an

abnormal incidence of groin herniation and then intra abdominal pressure does not
increase significantly in the erect posture. A single strenuous event preceded the
appearance of inguinal herniation is noted in only 7% of men questioned after
presentation.[48]

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