The role of matrix metalloproteinases in the pathogenesis of abdominal wall hernias.

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.