MON-PO597: The effect of a perioperative multinutrient supplement on collagen synthesis during early hernia repair: A randomised clinical pilot study

Rationale: The inguinal hernia disease is associated with an imbalanced collagen metabolism including attenuated type V collagen synthesis. The aim of the present study was to normalise this distorted collagen equilibrium by supplying a combination of nutrients necessary for collagen synthesis to patients undergoing inguinal hernia repair. Methods: Twenty-one male patients scheduled for Lichtenstein inguinal hernia repair were randomized to an enriched nutritional supplementation (ENS-protein) group receiving 55 mg zinc, 1250 mg vitamin C, 14 g arginine and 14 g glutamine daily (n = 10) or to a control group (n = 11). Both groups received 1.5 g/kg of high-quality protein daily for 28 days. In addition, experimental epidermal wounds were created from raised suction blisters. Biomarkers of type I (CICP), type III (PRO-C3) and type V (PRO-C5) collagen synthesis were measured by enzyme-linked immunosorbent assays together with zinc and free amino acids in serum collected at baseline (day -14), day 0 before surgery and on postoperative day 1 (day 1). Wound fluids from surgical drain were analysed for CICP, PRO-C3 and PRO-C5 on postoperative days 1 and 2. Results: Fourteen days of ENS-protein raised the serum zinc level (p = 0.002) but reduced (p = 0.022) total amino acid levels preoperatively. Postoperatively, serum PRO-C5 decreased (p = 0.046) in the protein group but not in the patients receiving ENS-protein, who also had higher (p = 0.041) PRO-C5 levels than the protein group on day 1. CICP wound fluid levels increased from day 1 to day 2 in both groups and were higher on day 2 in the ENS-protein group compared with the protein group (P = 0.029). PRO-C3 increased (p = 0.028) from day 1–day 2 in the ENS-protein group, but not in the protein group. One patient in the ENS-protein group developed wound infection and subsequent hernia recurrence. In the protein group, two patients developed wound infections and hernia recurred in three other pa