Reply To: How a non-mesh hernia repair heals
active_runner, I also am a very active runner and triathlete so hernia repair is definitely not what I wanted to go through! I’m almost two weeks out from a pure tissue repair: Modified Bassini.
I too am interested in the biochemical repair response for pure tissue repair. Unfortunately, I’m not a doctor, but I did find a helpful article on this great forum: The Role of Wound Healing and Its Everyday Application in Plastic Surgery: A Practical Perspective and Systematic Review. It has a good overview, but from my limited ability to understand, it seemed to apply more to the superficial healing at the skin level rather than the healing of the actual internal suture line.
Maybe one of the surgeons can describe the types of tissues that must rejoin, be it muscle, fascia, or whatever and how this works. As a runner I’ve torn my hamstring before and remember there is a mass of scar tissue that forms fairly quickly. There is some evidence in this type of muscular injury that gentle stretching early on can help the scar tissue collagen fibers to align correctly and make for a stronger rejoinder. I have no idea how this would apply to hernias though. I would caution against taking a hamstring tear approach to something so serious and with such high recurrence as a hernia repair without expert advice. There is one paper that claims lower recurrence rates in those engaged in active occupations; however, return to work is typically much longer in this population.
100 years or more ago, the convalescence period was extremely long, particularly to prevent recurrence. Now days I can’t seem to find any real definitive guidance, especially when it comes to pure tissue. My UpToDate subscription has expired and it has a sentence or two about this, but there are limited data that give percentage strength at various time intervals. I do remember a pure tissue repair had a longer time to full strength in at least one article. Apparently, the strength achieved is sigmoidal in time course, but I’m not sure this takes into account the sutures’ role and degradation (unless you have permanent sutures).
I do wonder also about the suture approach as the direction the sutures pull and cross would naturally create more tension in certain places and possible pockets of ischemia. A good surgeon is surely intimately acquainted with all of this.
I have read a bit about collagen type and repair. Recurrence rates seem to be somewhat related to your personal biochemistry as relates to collagen. So, I’m not sure there’s an exact answer to how the “reknitting” would go for you particularly. But I would be fascinated to hear anecdotal, published papers, and any general information from someone especially a medical doctor regarding how this process works on a biochemical level.