Abnormalities in collagen metabolism including: decreased hydroxylation, increased turnover of collagen molecules, increased serum elastase, and a decrease in antiproteolytic activity have been implicated as possible molecular causes of hernias. Patients with connective tissue disorders are at increased risk of hernias. Denerva-tion of the abdominal wall has also been implicated as a risk factor, and an increased incidence of right-sided inguinal hernias is observed after appendectomy. Pregnancy appears to be a risk factor for femoral hernias. Obesity and strenuous physical activity have not been shown to increase the incidence of groin hernias.

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