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