Compliance-Guided Abdominal Wall Closure Strategy in Large Ventral Hernia Repair

Inclusion Criteria: * Age 18 years or older * Elective repair of a large ventral abdominal wall hernia (including incisional hernia) * Preoperative botulinum toxin A preparation performed as part of the local prehabilitation pathway * Preoperative abdominal CT available * General anesthesia with mechanical ventilation and feasibility of standardized intraoperative respiratory mechanics measurements Exclusion Criteria: * Severe preoperative respiratory failure judged to preclude standardized intraoperative respiratory mechanics assessment * Inability to obtain reliable static respiratory system compliance measurements at predefined timepoints * Hemodynamic instability preventing protocolized measurements (as judged by the anesthesiologist)