Patient-Specific Finite Element Analysis of Ventral Incisional Hernia Repair: Biomechanical Investigation of the Cause of Recurrence.

Ventral incisional hernia is a frequent postoperative complication following abdominal surgery, with recurrence largely driven by biomechanical factors such as elevated intra-abdominal pressure and stress concentration at the suture-mesh-tissue interface. This study presents a patient-specific finite element analysis (FEA) framework to investigate stress transfer mechanisms within ventral incisional hernia repair systems under physiologically relevant loading conditions. A patient-specific abdominal wall geometry was reconstructed from computed tomography images and modeled as a nonlinear hyper-elastic material using a second-order Ogden formulation. Polypropylene surgical meshes and sutures were represented using finite elements, and an intra-lay mesh placement with a midline incision was simulated. Loading conditions corresponding to regular breathing, forceful breathing, and heavy-load lifting were applied. The results reveal that stress concentrations consistently localize at the sutures, with stress magnitudes increasing markedly under higher physiological loads. Under heavy lifting, suture stresses approached the material yield limit, whereas mesh stresses remained comparatively low. These findings identify suture failure as a critical mechanical factor contributing to hernia recurrence and highlight the importance of postoperative load management and improved support strategies. This work provides a basis for more comprehensive future patient-specific analyses.