Computational modeling of abdominal hernia laparoscopic repair with a surgical mesh

作     者：Todros, Silvia Pachera, Paola Baldan, Nicola Pavan, Piero G. Pianigiani, Silvia Merigliano, Stefano Natali, Arturo N. 

作者机构：Univ Padua Ctr Mech Biol Mat Dept Ind Engn Via Venezia 1 I-35131 Padua Italy Padova Gen Hosp Via Giustiniani 2 I-35128 Padua Italy Univ Padua Dept Surg Oncol & Gastroenterol Surg Clin 3 Via Giustiniani 2 I-35131 Padua Italy 

出 版 物：《INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY》 (国际计算机辅助放射学与外科学杂志)

年 卷 期：2018年第13卷第1期

页      面：73-81页

核心收录：

学科分类：0831[工学-生物医学工程（可授工学、理学、医学学位）] 1006[医学-中西医结合] 1002[医学-临床医学] 1009[医学-特种医学] 10[医学] 100602[医学-中西医结合临床] 

主　　题：Abdominal wall Laparoscopic hernia repair Surgical mesh Computational modeling 

摘      要：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 55mmHg, 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.