Background

Incisional hernia repair is burdened with recurrence, pain and disability. The repair is usually carried out with a textile mesh fixed between the layers of the abdominal wall.

Methods

We developed a bench test with low cyclic loading. The test uses dynamic intermittent strain resembling coughs. We applied preoperative computed tomography of the abdomen at rest and during Valsalva's maneuver to the individual patient to analyze tissue elasticity.

Findings

The mesh, its placements and overlap, the type and distribution of fixation elements, the elasticity of the tissue of the individual and the closure of the abdominal defect–all aspects influence the reconstruction necessary. Each influence can be attributed to a relative numerical quantity which can be summed up into a characterizing value. The elasticity of the tissues within the abdominal wall of the individual patient can be assessed with low-dose computed tomography of the abdomen with Valsalva's maneuver. We established a procedure to integrate the results into a surgical concept. We demonstrate potential computer algorithms using non-rigid b-spline registration and artificial intelligence to further improve the evaluation process.

Interpretation

The bench test yields relative values for the characterization of hernia, mesh and fixation. It can be applied to patient care using established procedures. The clinical application in the first ninety-six patients shows no recurrences and reduced pain levels after one year. The concept has been spread to other surgical groups with the same results in another fifty patients. Future efforts will make the abdominal wall reconstruction more predictable.

中文翻译：

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生物力学用于切口疝修补术–考虑到对压力相关影响的关键性和获得的抵抗力

背景

切口疝修补术充满了复发，疼痛和残疾。通常用固定在腹壁各层之间的纺织网进行修复。

方法

我们开发了具有低循环载荷的台架试验。该测试使用类似于咳嗽的动态间歇性应变。我们将静息期和瓦尔萨尔瓦（Valsalva）手术期间腹部的术前计算机体层摄影术应用于个别患者，以分析组织弹性。

发现

网格，其放置和重叠，固定元件的类型和分布，个体组织的弹性以及腹部缺损的闭合–所有方面都会影响必要的重建。每个影响都可以归因于一个相对的数值，可以将其相加为一个特征值。可以通过Valsalva动作对腹部进行小剂量计算机体层摄影术来评估单个患者腹壁内组织的弹性。我们建立了将结果整合到手术概念中的程序。我们演示了使用非刚性b样条配准和人工智能来进一步改进评估过程的潜在计算机算法。

解释

基准测试可得出疝气，网孔和固定物的相对值。可以使用既定程序将其应用于患者护理。最初的96名患者的临床应用显示，一年后无复发，疼痛程度降低。该概念已被推广到其他手术组，另外50名患者也获得了相同的结果。未来的努力将使腹壁重建更加可预测。