Musculoskeletal| Volume 195, ISSUE 2, P475-480, May 15, 2015

An analysis of the expression of collagen I and III genes in the fascia of obese patients

Published:January 20, 2015DOI:



      The etiology of incisional hernias in the population of morbidly obese patients remains unclear. Most likely, factors other than purely mechanical are at play; it has been ascertained that nonobese patients suffering from inguinal and incisional hernias display alterations in the architecture of the connective tissue. The goal of this study has been to evaluate and compare the relative expression of collagen type I and III genes in the rectus abdominis muscle sheath (RMS) of obese and nonobese individuals to investigate their possible influence on the quality of the connective tissue.

      Materials and methods

      RMS specimens were harvested in the early stages of either bariatric or non-bariatric laparotomies; total RNA was isolated and enzymatically purified from the tissue samples. The resulting material was subjected to a quantitative and qualitative analysis; reverse transcription reactions were then performed and the resulting complementary DNA was used in real-time reverse transcription polymerase chain reactions. The biopsy specimens were also examined by scanning electron microscopy.


      The real-time reverse transcription polymerase chain reactions, performed on complementary DNA, provided specific amplicons for individual genes. The efficacy of the reactions was rather low. An almost twofold decrease of the relative expression level for type I and III collagen was observed between the two patient groups; the results did not reach statistical significance. Scanning electron microscope photographs have documented a marked difference in the ultrastructure of the RMS in both groups.


      The authors have shown that changes in messenger RNA levels for collagen type I and III genes may be related to the pathogenesis of incisional hernia through alterations in the ultrastructure of the RMS fascia. Our report should be considered preliminary; the results should be verified on a larger group of patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sugerman H.J.
        • Kellum Jr., J.M.
        • Reines H.D.
        • DeMaria E.J.
        • Newsome H.H.
        • Lowry J.W.
        Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh.
        Am J Surg. 1996; 171: 80
        • Sauerland S.
        • Korenkov M.
        • Kleinen T.
        • Arndt M.
        • Paul A.
        Obesity is a risk factor for recurrence after incisional hernia repair.
        Hernia. 2004; 8: 42
        • Bonatti H.
        • Hoeller E.
        • Kirchmayr W.
        • et al.
        Ventral hernia repair in bariatric surgery.
        Obes Surg. 2004; 14: 655
        • Currò G.
        • Centorrino T.
        • Musolino C.
        • Sarra G.
        • Navarra G.
        Incisional hernia prophylaxis in morbidly obese patients undergoing biliopancreatic diversion.
        Obes Surg. 2011; 21: 1559
        • Strzelczyk J.M.
        • Szymański D.
        • Nowicki M.E.
        • Wilczyński W.
        • Gaszynski T.
        • Czupryniak L.
        Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery.
        Br J Surg. 2006; 93: 1347
        • Zheng H.
        • Si Z.
        • Kasperk R.
        • et al.
        Recurrent inguinal hernia: disease of the collagen matrix?.
        World J Surg. 2002; 26: 401
        • Klinge U.
        • Binnebösel M.
        • Mertens P.R.
        Are collagens the culprits in the development of incisional and inguinal hernia disease?.
        Hernia. 2006; 10: 472
        • Antoniou S.A.
        • Antoniou G.A.
        • Granderath F.A.
        • Simopoulus C.
        The role of matrix metalloproteinases in the pathogenesis of abdominal wall hernias.
        Eur J Clin Invest. 2009; 39: 953
        • Biondo-Simões Mde L.
        • Zammar G.R.
        • Fernandes Rdos S.
        • Biondo-Simões R.
        • Mello F.S.
        • Noronha Ld
        Obesity and abdominal wound healing in rats.
        Acta Cir Bras. 2010; 25: 86
        • Chang D.W.
        • Wang B.
        • Robb G.L.
        • et al.
        Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction.
        Plast Reconstr Surg. 2000; 105: 1640
        • Hopps E.
        • Caimi G.
        Matrix metalloproteinases in metabolic syndrome.
        Eur J Intern Med. 2012; 23: 99
        • Szczesny W.
        • Bodnar M.
        • Dabrowiecki S.
        • Szmytkowski J.
        • Marszałęk A.
        Histologic and immunohistochemical studies of rectus sheath in obese patients.
        J Surg Res. 2013; 180: 260
        • Jorgensen L.N.
        • Kallehave F.
        • Karlsmark T.
        • Gottrup F.
        Reduced collagen accumulation after major surgery.
        Br J Surg. 1996; 83: 1591
        • Jorgensen L.N.
        • Kallehave F.
        • Christensen E.
        • Siana J.E.
        • Gottrup F.
        Less collagen production in smokers.
        Surgery. 1998; 123: 450
        • Soybir O.C.
        • Gürdal S.Ö.
        • Oran E.Ş.
        • et al.
        Delayed cutaneous wound healing in aged rats compared to younger ones.
        Int Wound J. 2012; 9: 478
        • Chomczynski P.
        • Sacchi N.
        Single-step method of RNA isolation by acid guanidinium thiocyanate- phenol-chloroform extraction.
        Anal Biochem. 1987; 162: 156
        • Chomczynski P.
        • Sacchi N.
        The single-step method of RNA isolation by acid guanidinium thiocyanate-phenol-chloroform extraction: twenty-something years on.
        Nat Protoc. 2006; 1: 581
        • Luu-The V.
        • Paquet N.
        • Calvo E.
        • Cumps J.
        Improved real-time RT-PCR method for high-throughput measurements using second derivative calculation and double correction.
        Biotechniques. 2005; 38: 287
        • Pfaffl M.W.
        • Horgan G.W.
        • Dempfle L.
        Relative expression software tool (REST) for group-wise comparison and statistical analysis of relative expression results in real-time PCR.
        Nucleic Acids Res. 2002; 30: e36
        • Goodson 3rd, W.H.
        • Hunt T.K.
        Wound collagen accumulation in obese hyperglycemic mice.
        Diabetes. 1986; 35: 491
        • Enser M.
        • Avery N.C.
        Mechanical and chemical properties of the skin and its collagen from lean and obese-hyperglycaemic (ob/ob) mice.
        Diabetologia. 1984; 27: 44
        • Spear S.L.
        • Ducic I.
        • Cuoco F.
        • Taylor N.
        Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction.
        Plast Reconstr Surg. 2007; 119: 788
        • Friedman R.J.
        • Hess S.
        • Berkowitz S.D.
        • Homering M.
        Complication rates after hip or knee arthroplasty in morbidly obese patients.
        Clin Orthop Relat Res. 2013; 471: 3358
        • Huschak G.
        • Busch T.
        • Kaisers U.X.
        Obesity in anesthesia and intensive care.
        Best Pract Res Clin Endocrinol Metab. 2013; 27: 247
        • Nascimento A.P.
        • Costa A.M.
        Overweight induced by high-fat diet delays rat cutaneous wound healing.
        Br J Nutr. 2006; 96: 1069
        • Otranto M.
        • Nascimento A.P.
        • Monte-Alto-Costa A.
        Insulin resistance impairs cutaneous wound healing in mice.
        Wound Repair Regen. 2013; 21: 464
        • Si Z.
        • Bhardwaj R.
        • Rosch R.
        • Mertens P.R.
        • Klosterhalfen B.
        • Klinge U.
        Impaired balance of type I and type III procollagen mRNA in cultured fibroblasts of patients with incisional hernia.
        Surgery. 2002; 131: 324
        • Xing L.
        • Culbertson E.J.
        • Wen Y.
        • Robson M.C.
        • Franz M.G.
        Impaired laparotomy wound healing in obese rats.
        Obes Surg. 2011; 21: 1937
        • Lambert D.M.
        • Marceau S.
        • Forse R.A.
        Intra-abdominal pressure in the morbidly obese.
        Obs Surg. 2005; 15: 1225
        • Xing L.
        • Culbertson E.J.
        • Wen Y.
        • Franz M.G.
        Early laparotomy wound failure as the mechanism for incisional hernia formation.
        J Surg Res. 2013; 182: e35
        • Sezer S.
        • Şimşek N.
        • Celik H.T.
        • et al.
        Association of collagen type I alpha 1 gene polymorphism with inguinal hernia.
        Hernia. 2014 Aug; 18: 507
        • Calaluce R.
        • Davis J.W.
        • Bachman S.L.
        • et al.
        Incisional hernia recurrence through genomic profiling: a pilot study.
        Hernia. 2013; 17: 193