HEDI: First-Time Clinical Application and Results of a Biomechanical
  Evaluation and Visualisation Tool for Incisional Hernia Repair
Jacob J. Relle Samuel Voß Ramesch Raschidi Regine Nessel Johannes Görich Mark O. Wielpütz Thorsten Löffler Vincent Heuveline Friedrich Kallinowski Philipp D. Lösel
Abdominal wall defects often lead to pain, discomfort, and recurrence of
incisional hernias, resulting in significant morbidity and repeated surgical
repairs worldwide. Mesh repair for large hernias is usually based on the defect
area with a fixed overlap, without considering biomechanical aspects such as
muscle activation, intra-abdominal pressure, tissue elasticity, and abdominal
wall distention. To address this issue, we present a biomechanical approach to
incisional hernia repair that takes into account the unstable abdominal wall.
Additionally, we introduce HEDI, a tool that uses dynamic computed tomography
with Valsalva maneuver to automatically detect and assess hernia size, volume,
and abdominal wall instability. Our first clinical application of HEDI in the
preoperative evaluation of 31 patients shows significantly improved success
rates compared to reported rates, with all patients remaining pain-free and
showing no hernia recurrence after three years of follow-up.