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.
Similar content being viewed by others
References
DeFrances CJ, Cullen KA, Kozak LJ (2007) National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13:1–209
Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89:534–545
Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71
Bucknall TE, Cox PJ, Ellis H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J 284:931–933
Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias, nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400
Colavita PD, Tsirline VB, Walters AL, Lincourt AE, Belyansky I, Heniford BT (2013) Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample. Surg Endosc 27:109–117
Gopal SV, Warrier A (2013) Recurrence after groin hernia repair-revisited. Int J Surg 11:374–377
Cobb WS, Harris JB, Lokey JS, McGill ES, Klove KL (2003) Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. Am Surg 69:784–787
Bilsel Y, Abci I (2012) The search for ideal hernia repair; mesh materials and types. Int J Surg 10:317–321
Todros S, Pavan PG, Pachera P, Natali AN (2015) Synthetic surgical meshes used in abdominal wall surgery: part II-biomechanical aspects. J Biomed Mater Res B Appl Biomater. https://doi.org/10.1002/jbm.b.33584
Canchi T, Kumar SD, Ng EY, Narayanan S (2015) A review of computational methods to predict the risk of rupture of abdominal aortic aneurysms. Biomed Res Int. https://doi.org/10.1155/2015/861627
Doyle BJ, Callanan A, McGloughlin TM (2007) A comparison of modelling techniques for computing wall stress in abdominal aortic aneurysms. Biomed Eng OnLine 6:38
Pavan PG, Pachera P, Todros S, Tiengo C, Natali AN (2016) Mechanical characterization of animal derived grafts for surgical implantation. J Mech Med Biol 16:1650023
Hernández-Gascón B, Peña E, Grasa J, Pascual G, Bellón JM, Calvo B (2013) Mechanical response of the herniated human abdomen to the placement of different prostheses. J Biomech Eng 135:51004
Junge K, Klinge U, Prescher A, Giboni P, Niewiera M, Schumpelick V (2001) Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia 5:113–118
Hernández-Gascón B, Peña E, Melero H, Pascual G, Doblarè M, Ginebra MP, Bellón JM, Calvo B (2011) Mechanical behaviour of synthetic surgical meshes: Finite element simulation of the herniated abdominal wall. Acta Biomater 7:3905–3913
Muller M, Klinge U, Conze J, Schumpelick V (1998) Abdominal wall compliance after Marlex\(^{\textregistered }\) mesh implantation for incisional hernia repair. Hernia 2:113–117
Hernández-Gascón B, Peña E, Pascual G, Rodríguez M, Bellón JM, Calvo B (2012) Long-term anisotropic mechanical response of surgical meshes used to repair abdominal wall defects. J Mech Behav Biomed Mater 5:257–271
Pachera P, Pavan PG, Todros S, Cavinato C, Fontanella CG, Natali AN (2016) A numerical investigation of the healthy abdominal wall structures. J Biomech 49:1818–1823
Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128
Wildberger JE, Mahnken AH, Flohr T, Raupach R, Weiss C, Günther RW, Schaller S (2003) Spatial domain image filtering in computed tomography: feasibility study in pulmonary embolism. Eur Radiol 13:717–723
Hernández-Gascón B (2013) Mechanical modelling of the abdominal wall and biomaterials for hernia surgery. Dissertation, University of Zaragoza. https://zaguan.unizar.es/record/10400/files/TESIS-2013-042.pdf. Accessed 21 Mar 2017
Ahluwalia HS, Burger JP, Quinn TH (2004) Anatomy of the anterior abdominal wall. Oper Tech Gen Surg 6:147–155
Urquhart DM, Barker PJ, Hodges PW, Story IH, Briggs CA (2005) Regional morphology of the transversus abdominis and obliquus internus and externus abdominis muscles. Clin Biomech 20:233–241
Natali AN, Carniel EL, Gregersen H (2009) Biomechanical behaviour of oesophageal tissues: material and structural configuration, experimental data and constitutive analysis. Med Eng Phys 31:1056–1062
Natali AN, Carniel EL, Pavan PG, Dario P, Izzo I (2006) Hyperelastic models for the analysis of soft tissue mechanics: Definition of constitutive parameters. In: Proceedings of the first IEEE/RAS-EMBS international conference on biomedical robotics and biomechatronics, BioRob, pp 188–191
Guérin G, Turquier F (2013) Impact of the defect size, the mesh overlap and the fixation depth on ventral hernia repairs: a combined experimental and numerical approach. Hernia 17:647–55
Natali AN, Pavan PG, Stecco C (2010) A constitutive model for the mechanical characterization of the plantar fascia. Connect Tissue Res 51:337–346
Corana A, Marchesi M, Martini C, Ridella S (1987) Minimizing multimodal functions of continuous variables with the simulated annealing algorithm. ACM Trans Math Softw 13:262–280
Förstemann T, Trzewik J, Holste J, Batke B, Konerding MA, Wolloscheck T, Hartung C (2011) Forces and deformations of the abdominal wall—a mechanical and geometrical approach to the linea alba. J Biomech 44:600–606
Ben Abdelounis H, Nicolle S, Otténio M, Beillas P, Mitton D (2013) Effect of two loading rates on the elasticity of the human anterior rectus sheath. J Mech Behav Biomed Mater 20:1–5
Cardoso MHS (2012) Experimental study of the human abdominal wall. Dissertation, University of Porto. https://repositorio-aberto.up.pt/bitstream/10216/65576/1/000154315.pdf. Accessed 21 Mar 2017
Cobb WS, Burns JM, Kercher KW, Matthews BD, Norton HJ, Heniford BT (2005) Normal intraabdominal pressure in healthy adults. J Surg Res 129:231–235
Klinge U, Klosterhalfen B, Conze J, Limberg W, Obolenski B, Öttinger AP, Schumpelick V (1998) Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall. Eur J Surg 164:951–960
Konerding MA, Bohn M, Wolloscheck T, Batk B, Holste JL, Wohlert S, Trzewik J, Förstemann T, Hartung C (2011) Maximum forces acting on the abdominal wall: experimental validation of a theoretical modeling in a human cadaver study. Med Eng Phys 33:789–792
Song C, Alijani A, Frank T, Hanna GB, Cuschieri A (2006) Mechanical properties of the human abdominal wall measured in vivo during insufflation for laparoscopic surgery. Surg Endosc 20:987–990
Qandeel H, O’Dwyer PJ (2016) Relationship between ventral hernia defect area and intra-abdominal pressure: dynamic in vivo measurement. Surg Endosc 30:1480–1484
Welty G, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5:142–147
Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B, Parra-Davila E, Ramshaw B, Schumpelick V (2010) Hernia repair: the search for ideal meshes. Hernia 14:81–87
Todros S, Pavan PG, Natali AN (2017) Synthetic surgical meshes used in abdominal wall surgery: part I—materials and structural conformation. J Biomed Mater Res B Appl Biomater 105:689–699
Lambertz A, Stüben BO, Bock B, Eickhoff R, Kroh A, Klink CD, Neumann UP, Kronesb CJ (2017) Port-site incisional hernia—a case series of 54 patients. Ann Med Surg 14:8–11
Simón-Allué R, Hernández-Gascón B, Lèoty L, Bellón JM, Peña E, Calvo B (2016) Prostheses size dependency of the mechanical response of the herniated human abdomen. Hernia 20:839–848
Szymczak C, Lubowiecka I, Tomaszewska A, Smietański M (2012) Investigation of abdomen surface deformation due to life excitation: implications for implant selection and orientation in laparoscopic ventral hernia repair. Clin Biomech 27:105–110
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animals rights statement
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
This article does not contain patient data.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11548-017-1681-7