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Abdominal wall defects often lead to pain, discomfort, and recurrence ofincisional hernias, resulting in significant morbidity and repeated surgicalrepairs worldwide. Mesh repair for large hernias is usually based on the defectarea with a fixed overlap, neglecting biomechanical factors such as muscleactivation, intra-abdominal pressure, tissue elasticity, and abdominal walldistension. To address this issue, we present a biomechanical approach toincisional hernia repair that takes into account the unstable abdominal wall.Additionally, we introduce HEDI, a tool that uses computed tomography withValsalva maneuver to automatically detect and assess hernia size, volume, andabdominal wall instability. Our first clinical application of HEDI in thepreoperative evaluation of 31 patients shows significantly improved successrates compared to reported rates, with all patients remaining pain-free andexperiencing no hernia recurrence after three years of follow-up.

HEDI: First-Time Clinical Application and Results of a Biomechanical Evaluation and Visualisation Tool for Incisional Hernia Repair