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Purpose <p>The recurrence rate of ventral abdominal wall hernia repair remains high, partly due to incomplete understanding of biomechanical factors influencing fascial closure. This study aimed to develop and evaluate a patient-specific computational model to predict closure tension in the anterior rectus sheath (ARS) and posterior rectus sheath (PRS) during different steps of the transversus abdominis release (TAR) procedure.</p> Materials and Methods <p>A preoperative CT scan of a patient with a 7 × 6&#xa0;cm midline ventral hernia was segmented to reconstruct in 3D abdominal wall structures. Finite element meshes were generated for muscles, fasciae, aponeuroses, and the peritoneum. Tissue properties were assigned from experimental data and the abdominal cavity was modeled as a fluid-filled incompressible volume. The successive surgical steps of retrorectus dissection, incision of the posterior lamella of the internal oblique aponeurosis, and TAR, were simulated. Tension in ARS and PRS was computed and compared with <i>in vivo</i> measurements reported in the literature. Stress distributions in fascial components were also analyzed.</p> Results <p>The model successfully reproduced clinical trends of tension reduction reported <i>in vivo</i>. PRS tension decreased progressively from baseline to TAR (retrorectus dissection: − 16.7%, posterior lamella of the IO aponeurosis incision: − 60.0%, TAR: − 97.6%), while ARS tension dropped mainly after retrorectus dissection and remained stable thereafter (retrorectus dissection: − 45%, posterior lamella of IO aponeurosis incision: − 53.2%, TAR: − 54.0%). However, predicted baseline tensions appeared overestimated compared to clinical values. Stress analysis revealed redistribution between anterior and posterior fascial components during dissection.</p> Conclusion <p>This patient-specific computational model replicated <i>in vivo</i> tension trends, while overestimating absolute values. Model assumptions on material properties, fascial thickness, and abdominal cavity incompressibility may explain these discrepancies. A retrospective patient-specific validation study is warranted. Once validated, such models could guide surgical decision-making, help standardize TAR procedures, and enable patient-tailored hernia repair strategies.</p>

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Patient-Specific Computational Model of Abdominal Wall Simulating Hernia Defect Closure to Predict Tension in the Posterior and Anterior Rectus Sheath

  • 期刊论文

  • 发表日期：

    2026年3月11日

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  • Manar Jellal,
  • Arthur Jourdan,
  • Gaëtan-Romain Joliat,
  • Guillaume Passot,
  • Anicet Le Ruyet

摘要

Purpose

The recurrence rate of ventral abdominal wall hernia repair remains high, partly due to incomplete understanding of biomechanical factors influencing fascial closure. This study aimed to develop and evaluate a patient-specific computational model to predict closure tension in the anterior rectus sheath (ARS) and posterior rectus sheath (PRS) during different steps of the transversus abdominis release (TAR) procedure.

Materials and Methods

A preoperative CT scan of a patient with a 7 × 6 cm midline ventral hernia was segmented to reconstruct in 3D abdominal wall structures. Finite element meshes were generated for muscles, fasciae, aponeuroses, and the peritoneum. Tissue properties were assigned from experimental data and the abdominal cavity was modeled as a fluid-filled incompressible volume. The successive surgical steps of retrorectus dissection, incision of the posterior lamella of the internal oblique aponeurosis, and TAR, were simulated. Tension in ARS and PRS was computed and compared with in vivo measurements reported in the literature. Stress distributions in fascial components were also analyzed.

Results

The model successfully reproduced clinical trends of tension reduction reported in vivo. PRS tension decreased progressively from baseline to TAR (retrorectus dissection: − 16.7%, posterior lamella of the IO aponeurosis incision: − 60.0%, TAR: − 97.6%), while ARS tension dropped mainly after retrorectus dissection and remained stable thereafter (retrorectus dissection: − 45%, posterior lamella of IO aponeurosis incision: − 53.2%, TAR: − 54.0%). However, predicted baseline tensions appeared overestimated compared to clinical values. Stress analysis revealed redistribution between anterior and posterior fascial components during dissection.

Conclusion

This patient-specific computational model replicated in vivo tension trends, while overestimating absolute values. Model assumptions on material properties, fascial thickness, and abdominal cavity incompressibility may explain these discrepancies. A retrospective patient-specific validation study is warranted. Once validated, such models could guide surgical decision-making, help standardize TAR procedures, and enable patient-tailored hernia repair strategies.