News Feed Discussions How a non-mesh hernia repair heals

  • How a non-mesh hernia repair heals

    Posted by Unknown Member on January 19, 2018 at 6:16 am

    Hi everyone, this is my first post, I’ve found this forum quite informative and very helpful.

    Like many of you, I’m trying to decide between the mesh and non-mesh options.

    I have a specific question about how an open non-mesh repair heals, in particular the Shouldice or Desarda methods.

    I have a hard time watching the videos but from what I can tell, the idea that tissue is simply sewn together is basically how these repairs work.

    In the case of Desarda, a portion of the external oblique aponeurosis is basically repositioned to act as a patch providing reinforcement.

    My question is about the nature of this repair. How does it heal? Do the sutures provide the bond between tissues for the lifetime of the repair or is there tissue growth to establish a bond? Does the area where the aponeurosis was displaced regrow new tissue? Is this type of fix “strong” enough for an active athlete?

    Thanks for all your help. I really appreciate the honesty everyone shows on this forum!

    Jnomesh replied 6 years, 4 months ago 3 Members · 2 Replies
  • 2 Replies
  • Jnomesh

    January 21, 2018 at 5:57 pm

    I read a article/paper that said the repair is 75% healed at 6 months and 100% healed at about a year. I’ve also heard from others and my own surgeon that even when 100% healed from the hernia repair the area is still only 80% as strong as before the hernia.

  • oqhpeoi2495

    January 21, 2018 at 4:12 pm

    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.

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