Smoking is bad for your health! It’s not at all unusual for me to bring up this old saying again today, but if I were to link smoking to a “hernia”, it would probably confuse most people. It is true that smoke is inhaled into the lungs, which is a hundred thousand miles away from the groin area, and it is impossible to understand the connection between the two. As a physician specializing in hernia surgery, I have searched for relevant articles on smoking and hernia, analyzed and summarized them, and shared them with you in the hope that they will serve as a warning to smokers. As Prof. Chen Jie mentioned in his health lecture: there are 2 necessary conditions for the occurrence of hernia, one is a weakness or defect formed on the abdominal wall either congenitally or later in life, and the other is a factor of increased abdominal pressure, such as cough, pregnancy, cirrhotic ascites, obesity, etc. Among them, coughing is the most common and most easily understood and at the same time the least concerned action to increase abdominal pressure. Such a description does not mean that coughing occasionally due to cold will have any decisive role in the occurrence of hernia, but smokers, especially elderly smokers, have a significantly increased chance of chronic lung diseases such as chronic obstructive pulmonary disease (COPD), and such people will have prolonged coughing and These actions can cause a significant increase in abdominal pressure over a period of time, which in turn can lead to a significant increase in the likelihood of hernia. In addition to coughing to increase abdominal pressure, the effect of smoking on collagen metabolism is also an important cause of hernia. Some foreign scholars have studied the relationship between normal and abnormal collagen fiber metabolism and hernia etiology in smokers and found that smokers have elevated levels of protease and elastase in the blood circulation, which disturbs the balance between the protease and anti-protease systems in the blood circulation and disrupts the rectus abdominis sheath and transversus abdominis fascia, making the transversus abdominis fascia weak and prone to induce hernias. Smokers have a high recurrence rate after inguinal hernia repair due to nicotine, carbon monoxide and other reactive substances that can cause tissue hypoxia, less collagen aggregation in their wounds than nonsmokers, and reduced hydroxyproline content. In addition, smoking can lead to a decrease in matrix metalloproteinases (MMPs) inhibitory activity and an increase in type III collagen, which is strongly associated with the development of hernias. Because smoking hinders collagen synthesis, it not only affects the wound healing of the hernia, but also contributes to its recurrence. The biochemical structure of normal human tissues shows that the important substances that make up the tendon membrane and fascia of the abdominal muscles and give them a certain tension (tensile strength) are the fibrous tissues such as collagen and elastin. Therefore, their destruction, of course, severely weakens the protective function of the fascial layer of the transversus abdominis tendon, an important barrier in the inguinal cavity that cushions the abdominal pressure, and predisposes to inguinal hernia. In conclusion, in today’s society, with the accelerated aging of the population, the incidence of hernia as a degenerative disease is on the rise year by year, and it is conservatively estimated that the number of patients suffering from the disease is increasing at the rate of 2 million per year in China, while only a hundred thousand patients are in a position to undergo surgery. The daytime tension-free hernia repair under local anesthesia advocated by Director Chen Jie has brought a boon to the majority of patients with short hospital stay (1-2 days), low cost and quick recovery. But for all diseases, prevention is also an important part of disease control. I hope that through health promotion, the majority of smokers will have a new understanding of the dangers of smoking and a deeper understanding of the causative factors of hernia.