For a surgical procedure to result in patients being universally pain free, with zero recurrence of the ailment seems impossible - but that’s what’s been achieved by a new hernia analysis tool co-developed at ANU.

ANU imaging expert Dr Philipp Lösel worked with a team of medical doctors from Germany, led by Professor Friedrich Kallinowski from Heidelberg University Hospital, to develop an innovative approach to analysing hernias, which transforms the success of the surgery.

“When Friedrich told me none of the patients needed further treatment or have any further suffering, it was amazing!” Dr Lösel said.

The analysis was applied to incisional hernias of the abdomen. There are millions of operations on this affliction worldwide every year, costing over $1 billion.

Incisional hernias can be extremely painful, limiting patients’ movement. They result from incompletely healed surgical incisions, through which tissue or organs bulge out.

“These hernias often arise from prior treatments, like cancer removal. So even though these patients are cured of their cancer, they are in great pain and are unable to get out of bed, and often need opioids,” Dr Lösel said.

The tool is named HEDI (Hernia Evaluation, Detection, and Imaging) and is open source. The research is published in Communications Medicine. The paper reports the results from 31 patients, and since publication the total number of patients treated has tripled, still with a near perfect record.

Dr Lösel used CT scans to analyse the bulge both at rest and under pressure, (created using a medical technique known as the Valsalva manoeuvre). From these two images he built a 3D picture of the injury under load that enabled surgeons to plan optimal surgery.

Previous approaches had not adequately considered the individual biomechanical properties of the abdominal wall, such as muscle activity, tissue elasticity, and intra-abdominal pressure. However with the new information the surgeons were able to decide on the exact size, strength and location for the reinforcing mesh to treat the hernia.

Initial Dr Lösel tried using a 2D approach, but found it wasn’t adequate to represent the three-dimensional behaviour of the abdomen. So he moved to 3D scans, even though they are more computationally intensive.

“Tracking the movement of each voxel of the images in 3D was challenging, because of the non-rigid deformation,” he said.

Eventually an algorithm was developed, and the team cross checked its reliability by comparing against the movement of markers that were adhered to the patients’ abdomen.

Each analysis takes around 15 minutes on a standard workstation, and so had to be performed in advance of the operation. The team hope that in the future it can be better integrated into the clinical routine.

Dr Lösel said patients also found the images helpful.

“It’s nice to have this visualisation for the patient. The surgeons showed them the image on an iPad or print out to explain what’s going on,” he said.