[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.

[oqhpeoi2495]

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.

[oqhpeoi2495]

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.

[oqhpeoi2495]

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.