Clinical application of HEDI for biomechanical evaluation and visualisation in incisional hernia repair

TL;DR

This study introduces HEDI, a biomechanical assessment and visualization tool using CT with Valsalva to improve preoperative planning for incisional hernia repair, showing promising early results.

Contribution

The paper presents a novel biomechanical approach and visualization tool for incisional hernia repair that considers abdominal wall dynamics, enhancing surgical planning.

Findings

All 31 patients remained pain-free and hernia-free after three years.

HEDI provides valuable insights into abdominal wall dynamics.

The tool supports but does not replace surgical decision-making.

Abstract

Background: Abdominal wall defects, such as incisional hernias, are a common source of pain and discomfort and often require repeated surgical interventions. Traditional mesh repair techniques typically rely on fixed overlap based on defect size, without considering important biomechanical factors like muscle activity, internal pressure, and tissue elasticity. This study aims to introduce a biomechanical approach to incisional hernia repair that accounts for abdominal wall instability and to evaluate a visualisation tool designed to support surgical planning. Methods: We developed HEDI, a tool that uses computed tomography with Valsalva maneuver to automatically assess hernia size, volume, and abdominal wall instability. This tool was applied in the preoperative evaluation of 31 patients undergoing incisional hernia repair. Surgeries were performed concurrently with the development of the tool, and patient outcomes were monitored over a three-year period. Results: Here we show that all 31 patients remain free of pain and hernia recurrence three years after surgery. The tool provides valuable visual insights into abdominal wall dynamics, supporting surgical decision-making. However, it should be used as an adjunct rather than a standalone guide. Conclusions: This study presents a biomechanical strategy for hernia repair and introduces a visualisation tool that enhances preoperative assessment. While early results are promising, the tool's evolving nature and its role as a visual aid should be considered when interpreting outcomes. Further research is needed to validate its broader clinical utility.