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Computational modeling of abdominal hernia laparoscopic repair with a surgical mesh

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Although new techniques and prostheses have been introduced in ventral hernia surgery, abdominal hernia repair still presents complications, such as recurrence, pain, and discomfort. Thus, this work implements a computational method aimed at evaluating biomechanical aspects of the abdominal hernia laparoscopic repair, which can support clinical research tailored to hernia surgery.

Methods

A virtual solid model of the abdominal wall is obtained from MRI scans of a healthy subject. The mechanical behavior of muscular and fascial tissues is described by constitutive formulations with specific parameters. A defect is introduced to reproduce an incisional hernia. Laparoscopic repair is mimicked via intraperitoneal positioning of a surgical mesh. Numerical analyses are performed to evaluate the mechanical response of the abdominal wall in healthy, herniated and post-surgery configurations, considering physiological intra-abdominal pressures.

Results

During the deformation of the abdominal wall at increasing pressures, a percentage displacement increment up to 6% is found in the herniated condition, while the mechanical behavior of the repaired abdomen is similar to the healthy one. In the pressure range between 8 mmHg and 55 mmHg, the herniated abdomen shows an incremental stiffness differing of 7% with respect to the healthy condition, while the post-surgery condition shows an increase of the incremental stiffness up to 58%.

Conclusions

This computational approach may be exploited to investigate different aspects of abdominal wall surgical repair, including mesh mechanical characteristics and positioning. Numerical modeling offers a helpful support for selecting the best-fitting prosthesis for customize pre-surgery planning.

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Authors and Affiliations

  1. Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Venezia 1, 35131, Padua, Italy

    Silvia Todros, Paola Pachera, Piero G. Pavan, Silvia Pianigiani & Arturo N. Natali

  2. Padova General Hospital, via Giustiniani 2, 35128, Padua, Italy

    Nicola Baldan

  3. Department of Surgery, Oncology and Gastroenterology, III Surgical Clinic, University of Padova, via Giustiniani 2, 35131, Padua, Italy

    Stefano Merigliano

Authors
  1. Silvia Todros
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  2. Paola Pachera
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  3. Nicola Baldan
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  4. Piero G. Pavan
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  5. Silvia Pianigiani
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  6. Stefano Merigliano
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  7. Arturo N. Natali
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Correspondence to Silvia Todros.

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Todros, S., Pachera, P., Baldan, N. et al. Computational modeling of abdominal hernia laparoscopic repair with a surgical mesh. Int J CARS 13, 73–81 (2018). https://doi.org/10.1007/s11548-017-1681-7

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  • DOI: https://doi.org/10.1007/s11548-017-1681-7

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