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Surgical Approach for Active Adult – Modified Bassini
I’ve read read so many posts and they’ve been very helpful. Thank you to all who have contributed! My question concerns returning to activity based on surgical approach.
I had a direct inguinal hernia repaired a week ago. My body bounced back really fast. I’m in almost no pain and definitely feel as though I could run. But I won’t run until a meet with my surgeon for a 10 day followup and get clearance. I do have considerable swelling.
My question concerns surgical approach. I told my surgeon I was very active and run a lot at the evaluation appointment. But he didn’t say which approach he’d take with the repair. From hours of research over the last week, I’ve discovered there are multiple repair approaches to the abdominal defect.
The surgery can be open or laparoscopic and the repair can be with or without mesh. From reading dozens of journal articles and even a hernia textbook, I discovered that surgery with mesh is by far the most common. The Lichtenstein Repair is extremely common as an open repair and sometimes stated as the gold standard. There is also the Shouldice repair which is highly regarded by some.
I found out after the surgery that my surgeon performed a Modified Bassini repair. I have the post-op report. As I understand it, this repair just stitches the defect back together without mesh. From what I’ve read, this approach has a high rate of recurrence. I live in a large metropolitan area, have great insurance, and the surgeon is extremely highly regarded in the city. It was an elective surgery and there was no heightened risk of infection.
Why would he choose a Modified Bassini for someone like me who is extremely active? I called his office and apparently he performs this type of repair in almost all cases. He reserves mesh for large or complicated repairs. Up to Date even says tissue approximation repairs like Bassini have a prolonged return to activity because the tissue has to repair itself.
One article says Bassini is reserved for children and older, inactive people or where cost is at issue. With mesh repairs, I’ve read of people running extremely soon after surgery. Some hernia centers even boast returning to activity with only pain being the guide; almost claiming you can’t cause a recurrence from activity, the mesh repair is completely strong immediately after placed. My repair was sutured with 3-0 Vicryl.
So I am very disappointed that I wasn’t guided toward a repair that would work best for my extremely active lifestyle. I take some blame for not asking more questions, but I trusted the surgeon. He’s one of the most well known general surgeons in a top 10 U.S. city.
Anyone else have a Modified Bassini or anyone have any anecdotes about what repair they had and what returning to activity looked like? Am I overreacting and the Modified Bassini is really a perfectly appropriate technique for an active person. Not running is torture and I’m ready to get back out there. And I’m practically pain free and could certainly slow jog. Thanks!
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15 Replies
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[USER=”2369″]oqhpeoi2495[/USER], I have sent you a message requesting the name of the surgeon you had for the non-mesh repair. If you didn’t get the message, please send the non-mesh surgeons name to me.
Thanks in advance, and please keep us updated on your progress!
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quote oqhpeoi2495:The prior mesh does cause some pain when I do core exercises. To the point I actually had a very thorough ultrasound done to make sure everything was ok. Message me if you need the name of the non-mesh surgeon. It’s not a specialized hernia center, the surgeon is a general surgeon located in Texas.
Thank you. I was mainly just curious about your prior mesh experience. Sounds like most of the time it’s ok but certain movements and exercises cause pain to some degree. I guess this is what people worry about – mesh fixing the original hernia but not getting back to 100%. Obviously some people have much, much worse experiences as well, which seem to be fairly ‘rare’. But experiences like yours seem to be much more common. Glad to know the current situation sounds like it’s going well. I’d always heard the non-mesh repairs had a longer and more difficult recovery.
I personally was considering a non-mesh surgery myself after reading about all the issues people have had with mesh, but all of the surgeons I spoke with said if it were them, they would personally use mesh on themselves if they had a hernia. And I know a couple more surgeons that have actually had the surgery themselves and they used mesh as well. That said, the results of the non-mesh approach seem to be excellent under skilled hands, and you don’t have any of the worries that come with mesh and a foreign body. So I think either is a good option if you have a skilled surgeon involved. Only time will tell how things will end up in any case for any one individual, and complications and pain are possible with either approach and even with the most skilled surgeons. Six of one, half dozen of another. All of which makes the patient’s decision so difficult. Guess you gotta do a little homework, find a good surgeon and then make a decision and commit to it and hope for the best.
Good luck with the rest of your recovery
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The prior mesh does cause some pain when I do core exercises. To the point I actually had a very thorough ultrasound done to make sure everything was ok. Message me if you need the name of the non-mesh surgeon. It’s not a specialized hernia center, the surgeon is a general surgeon located in Texas.
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so no issues with your prior mesh repair from 18 years ago? that’s good to hear. where did you get the latest surgery?
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I’m happy to share anything about my case. I appreciate the kind encouragement regarding non-mesh repairs. I had my two week followup appointment this week and the surgeon said everything looks great. I do still have what looks to me like swelling, but I guess I’m so thin (BMI ~20) he said it is just the suture line and that it should go down over the next 3-4 weeks. I don’t understand what that means, but I do hope it goes away as it bulges as much, if not more, than it did prior to surgery. I did cordially ask why he chose non-mesh and he cited mesh complications in his very brief answer.
I’ll try to answer Chaunce1234’s questions. Prior to surgery I had virtually no symptoms. I’m a runner/triathlete and was diagnosed with a stress fracture in my foot, so I decided to have the hernia repaired since I couldn’t train anyway. I did the “watch and wait” for about 5 years. It did seem to be growing, particularly over the prior 2-3 months, and in the post-op report, the surgeon described it as a “large direct hernia.” Compared to pictures I’ve seen, I don’t think mine was particularly large. Prior to surgery, I had a visible bulge when standing but nothing too dramatic; coughing did make it bulge more.
The surgery was incredibly smooth. I had an inguinal hernia repaired on the other side, incidentally with mesh, 18 years ago and the recovery for it was much more painful. So, I can accurately describe my post-op recovery as quite remarkable. For the prior hernia I walked hunched over and experienced significant discomfort when transitioning from lying to standing. For this repair I didn’t take any prescription pain medication and didn’t even take regular Tylenol the first night. I did take Tylenol for the next three days.
I walked to the end of the block and back the day after surgery and have continued to increase walking so I’m now walking 45 minutes or so at a time. The most difficult part of the whole procedure is the restriction on exercise. A couple weeks out, I feel great and don’t expect I’d have any trouble swimming, biking, running, etc.; however, the surgeon is restricting activity for a full six weeks. Absolutely nothing but walking. At six weeks I can do whatever I want.
I certainly don’t want to cause a recurrence and because my surgeon knows exactly what he did, I’ll stick to his advice. But I’m curious if others agree with this level of caution. 18 years ago, I believe I was permitted to run at two weeks, which I did. Maybe the six week benchmark is something new? Considering my experience last time and internet research, I expected it would only be 2-4 weeks out of training and didn’t think to ask beforehand. I was surprised!
I can’t think of anything particularly notable about my case, except that it was non-mesh, something I didn’t seek out or expect, and it seems is rare these days. I honestly have no idea whether non-mesh or mesh is the better option. I think this is so highly debatable that the surgeons on this forum don’t want to touch the issue. There probably isn’t a clear answer. Unfortunately in medicine, it seems there rarely is. Some will and have experienced nightmarish complications from mesh. I’m sure plenty have had chronic pain following non-mesh also. This isn’t a surgery to be taken lightly. Find a surgeon who does a lot of hernia repairs and is really committed to their practice.
I really feel for those who have experienced complications, regardless of the surgical approach. I’ve received messages from several. I do hope others experience a good outcome as I have so far. At this point I’m just waiting to see if the “swelling” goes down as predicted and what returning to my exercise regimen will be like: whether I will finally experience some pain or whether that will go equally smoothly.
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It sounds like you’ve made great progress for a week out of surgery and had an excellent surgeon, so I would be happy and not worry, particularly given that you’ve had a stellar outcome thus far.
Data shows the non-mesh repair to be excellent when performed by an expert on the appropriate patient profile (fit, not obese). Several of the most well-known groin injury and hernia surgeons in the professional sports world routinely perform the non-mesh procedure on professional athletes and other fit patients, presumably for a reason. Also, the Shouldice hospital performs almost exclusively non-mesh repairs and has a 1% recurrence rate and remarkably low chronic pain incidence. So expertise matters, particularly given the complex nature of the surgery in a very complex region of the body.
Can you share some additional details about your case? What were your symptoms like prior to surgery? Did you have pain, a bulge, anything remarkable? If you were symptomatic beforehand, are the symptoms changed or resolved now post-surgery?
Please do share the name of your surgeon and their location. It is increasingly difficult to find non-mesh hernia experts, thus sharing this information can be valuable to other patients seeking similar surgical options.
Best of luck and keep us up to date on your case and progress.
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Thanks oqhpeoi2495 I just sent you a private message
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Thank you for the replies! I’m sorry it has taken me awhile to get back with a report. In my post I made it sound like my doctor was at fault somehow when really I was the one who should have asked more questions. I think it’s always a good rule of thumb to ask lots of questions. This surgery is far from simple. The groin in particular is a very complex area.
Your replies really have helped me relax a lot. I was pretty freaked out at first, mostly because of the recovery time. As some of you noted, I am very low body fat and this may have been the best choice for me. My surgeon is older and extremely experienced. He used Ethicon 3-0 sutures, so I don’t think cost was a consideration. He is so dedicated to his work, I am confident he truly believes that the repair approach he took was in my best interest.
I suppose only time will tell whether I have a recurrence. I am having fairly significant swelling at the repair site. I haven’t had my followup appointment yet, but from the things I’ve read, this should go down in a matter of weeks to months. I do worry that the swelling might compromise the repair, but I have no fever or indications of infection, so all should be fine.
I’m hesitant to mention the name of my doctor to be permanently posted on the internet, but if you would like the name, you’re welcome to send me a message.
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Please share the name and location of the surgeon. Many of us are actually in search of a surgeon who offers a non- mesh repair. I think you are actually lucky to have had this repair type. Thanks
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quote Good intentions:Many people have problems with mesh. It’s unclear why. There are many different types of mesh and many different techniques for placing it. Generally, anecdotally, athletic people with low body fat have more problems with mesh. More chronic pain. You can find a many success stories and many horror stories. So many stories that there will be no clear “winners”, or losers. Recurrence is only one aspect of a successful hernia repair. The other big one is chronic pain.
So, your surgeon might have done you a favor, in the long run. If he is trained in the various mesh placement techniques and uses mesh, but he chose the modified Bassini repair he must have thought you were a good candidate for it. Mesh is generally considered to have a lower recurrence rate, and seems to be the “safe” route to take, based only on recurrence rates.
You should really be focused on the long term, not the next two weeks, or two months, or the fact that you’re losing your conditioning. If you go too fast and create problems you could have serious regrets, and be out of running for much longer. Maybe forever if things go really bad. Hernia repair is simple in principle and description but complex in practice. I was a very active runner and soccer player until I had laparoscopic mesh implantation with Bard Soft Mesh. It ruined me for athletics and running and hiking. It’s hard to say that you’d be better off with mesh implantation.
Good luck.
I agree.I am very sorry to hear how you are now sidelined from physical activity.I too am ruined for athletics and it has cost me my life as a personal trainer/bodybuilder.
My doctor did a great job overall with my mesh repair but now 8 years later the mesh says otherwise.One thing I wish my doctor didn’t do though was insist on mesh since I wanted to return to the gym.Since this hernia issue was new to me I felt rushed and went by his word.
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You should feel very fortunate that you had a non mesh repair. There are many people on this forum and elsewhere that have had life altering negative impacts of mesh. It can do terrible damage in one’s body. Let your body heal up and don’t rush it and you will recover find. You are fortunate to have found a surgeon who specializes in a tissue repair.
Please share his name and city as others may be looking for a surgeon whom does non mesh repairs as these surgeons are very hard to find in the US -
I had written a much longer response this morning but it was “Unapproved” and not allowed, apparently.
Anecdotally, athletic people with low body fat have more mesh problems than the average person. Might be why he used the modified Bassini approach. You might actually be better off.
Think long-term. Let it heal properly before trying to get back to your old self, I’d say.
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Consider yourself very lucky to have a non mesh repair and done by a surgeon who specializes in doing many of these repairs. Many people do well with mesh repairs but many don’t and have chronic pain. Mesh can fold, migrate, crumble attaché to the ground nerves and other organs and 99% of the surgeons out there don’t know how to or won’t remove the mesh. Mesh is a piece of plastic that is the same material used to make tic tax boxes it is unatural. There are many people on this forum and out there who have nightmarish experience with mesh-pain you can’t imagine.
I would thank your surgeon. I had to have met mesh removed-the pain was unimaginable and very doctor and test told me nothing was wrong until I finally found someone who was able to tell me it had folded into a rock hard ball and attached to all sorts of organs and nerves.
Pkease take your time to heal and you will do fine. Don’t act like Superman and give it time at least 6 months. But talk more to your surgeon for answers on activity.
there are many people out there including me that wish I didn’t have put mesh inside of me.
it is almost impossible to find surgeons in the US who do pure tissue repairs-maybe you could be kind enough to share the surgeons name and city as other people can have a choice for a natural repair instead of mesh. -
There are several posts on this forum about how mesh sometimes does not work well for athletic people with low body fat. Could be that your surgeon did consider your activity level and gave you the most appropriate solution.
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Many people have problems with mesh. It’s unclear why. There are many different types of mesh and many different techniques for placing it. Generally, anecdotally, athletic people with low body fat have more problems with mesh. More chronic pain. You can find a many success stories and many horror stories. So many stories that there will be no clear “winners”, or losers. Recurrence is only one aspect of a successful hernia repair. The other big one is chronic pain.
So, your surgeon might have done you a favor, in the long run. If he is trained in the various mesh placement techniques and uses mesh, but he chose the modified Bassini repair he must have thought you were a good candidate for it. Mesh is generally considered to have a lower recurrence rate, and seems to be the “safe” route to take, based only on recurrence rates.
You should really be focused on the long term, not the next two weeks, or two months, or the fact that you’re losing your conditioning. If you go too fast and create problems you could have serious regrets, and be out of running for much longer. Maybe forever if things go really bad. Hernia repair is simple in principle and description but complex in practice. I was a very active runner and soccer player until I had laparoscopic mesh implantation with Bard Soft Mesh. It ruined me for athletics and running and hiking. It’s hard to say that you’d be better off with mesh implantation.
Good luck.
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