Systemic biomarkers currently implicated in the formation of abdominal wall hernia: A systematic review of the literature

Surgery to the abdominal wall is ubiquitous worldwide and hernia treatment is challenging and expensive, posing a critical need to tailor treatment to individual patient risk-factors. In this systematic review, we consider specific systemic factors with potential as biomarkers of hernia formation. A healthcare database-assisted search, following PRISMA guidelines, identified journal articles for inclusion and analysis. 14 biomarker studies were selected, comparing hernia patients and hernia-free controls, focusing on markers of extracellular matrix (ECM) remodelling and collagen turnover. Matrix metalloproteinase-2 was increased in patients with inguinal hernia. Markers of type IV collagen synthesis were increased in patients with abdominal wall hernia; while markers of fibrillar collagen synthesis were reduced. Additional other ECM signalling proteins differ significantly within published studies. We identify a lack of high-quality evidence of systemic biomarkers in tailoring treatment strategies relative to patient-specific risks, but recognise the potential held within biomarker-based diagnostic studies to improve management of hernia pathogeneses. •Biomarkers of ECM remodelling may play a significant role in reducing future hernia-related morbidity.•MMP-2 is elevated in subjects with inguinal hernia.•P4NP may predict hernia development.•Reduced fibrillar collagen synthesis is associated with abdominal wall hernia.•Standardisation need be incorporated into future risk-assessment biomarker studies.