Can We Predict the Need of Performing a Component Separation Technique?

Introduction Components separation is a surgical technique (CST) used in abdominal wall (AW) reconstruction. It facilitates the reapproximation of the linea alba and provides soft tissue coverage over the mesh, as well as AW restoration. However, employing this technique may be associated with a higher risk of post-operative complications. Currently, there is no consensus on the method for identifying patients who would benefit from a CST. In this work, we developed a numerical framework based on pre-operative CT-scan images assessing the force required to reapproximate the defect before and after a posterior CST. Methods The myofascial structure in 10 pre-operative CT-scans were manually segmented. Once the geometry reconstructed, a computational model based on the finite-element method was developed. Material properties such as elasticity and anisotropy were assigned to each component of the model, while the abdominal cavity was assumed to be incompressible. The reapproximation of the defect was then simulated both before and after a posterior CST. Results Depending on the side where the CST was simulated, there was a significant variation in the force required to reapproximate the defect. Simulating a posterior CST resulted in up to a 50% decrease in the necessary force (as shown in the Figure) and a reduction of up to 25% in the resulting intra-abdominal pressure. Conclusion Although the credibility of this framework has yet to be validated through comparison of the model’s predictions with experimental data, this approach presents a promising new patient-specific method for assessing the clinical benefits of posterior CST.