Biomechanics of the abdominal wall before and after ventral hernia repair using dynamic MRI

TL;DR

This study uses dynamic MRI to analyze abdominal wall biomechanics before and after ventral hernia repair, revealing significant changes and variability that can inform personalized treatment strategies.

Contribution

It introduces a semi-automatic MRI-based method for detailed, patient-specific assessment of abdominal wall biomechanics in hernia patients.

Findings

Post-surgical reduction in inter-recti distance by 26%

Significant muscle lengthening observed after surgery

High variability in biomechanical responses among patients

Abstract

Purpose: This study aims to investigate the use of dynamic MRI to assess abdominal wall biomechanics before and after hernia surgery, considering that such evaluations can enhance our understanding of physiopathology and contribute to reducing recurrence rates. Methods: Patients were assessed using dynamic MRI in axial and sagittal planes while performing exercises (breathing, coughing, Valsalva) before and after their abdominal hernia surgery with mesh placement. Rectus and lateral muscles, linea alba, viscera area, defect dimensions and hernia sac were contoured with semi-automatic process to quantify the abdominal wall biomechanical temporal modifications. Results: This study enrolled 11 patients. During coughing, the axial area of the hernia sac increased by 128.4 $\pm$ 199.2%. The sac increased similarly in axial and sagittal planes during Valsalva. Post-surgical evaluations showed a 26% reduction in inter-recti distance and a lengthening of all muscles (p $\le$ 0.05). The post-operative rectus abdominis thickness change was negatively correlated with defect width during breathing (p $\le$ 0.05). The largest change in linea alba displacement was observed in the surgical site (p = 0.07). Post-operatively, lateral muscles had a larger inward displacement during Valsalva (p $\le$ 0.05). Rectus abdominis had a larger outward displacement during breathing (p = 0.09), reduced with the mesh size (p $\le$ 0.05). A large inter-individual variability was observed. Conclusion: Using a semi-automatic methodology, an in-depth analysis of the biomechanics of the abdominal wall was conducted, highlighting the importance of a patient-specific assessment. A broader study and consideration of recurrence would subsequently complete this methodological work.