Transversalis fascia collagen content and the risk of surgical complications: results of a prospective study.

BACKGROUND: Collagen is the major protein of the extracellular matrix that provides mechanical strength to the tissues. The relationship between the development of complications and the quality and quantity of collagen fibres has not been investigated in the literature, yet. METHODS: This was a prospective study of 392 patients who underwent subcostal laparotomy for confirmed or suspected gastrointestinal malignancy. Prior to abdominal closure a sample of transversalis fascia was collected. The area covered by collagen (ACC) was measured as the mean area covered by Picosirius stained fibres in three areas of the fascia. The primary endpoint of the study was the occurrence of complications, graded according to the Clavien-Dindo over a 90-day follow-up period. RESULTS: 392 patients were included in the study. A transversalis fascia sample was obtained in 354 patients (90.3%) and image assessment yielded a group of 259 specimens that were included in the analysis (66.1%). Predicting the development of complications of at least CD III based on ACC was associated with an AUC of 0.606 (p = 0.027) and an optimal threshold of 0.771. There were significantly fewer complications of at least CD III in the group of patients with ACC ≥ 0.771 (6/125) than in the group below the threshold (25/134) (p < 0.01). CONCLUSIONS: Collagen content may serve as an adjunct predictor of surgical risk, although its clinical utility requires further validation. There is a need for further studies on the causal nature of this relationship and modifiable risk factors related to body collagen quality.