Hernia Neck Research Articles

Evaluation and Analysis of the Clinical Effects of Laparoscopic Surgery for Pediatric Direct Inguinal Hernia.

Objective: To assess both the clinical effectiveness and practical experience of utilizing laparoscopic methods for addressing direct inguinal hernia in the pediatric population. Method: The study collected clinical data from 10 pediatric patients with direct inguinal hernia treated at the Children's Hospital of Anhui Province from July 2014 to July 2023. Among them, there were 8 males and 2 females, with an average age of 43.4 ± 22.0 months. All were initially diagnosed with indirect inguinal hernia before surgery. During the laparoscopic procedures, direct hernia was confirmed. Two cases had undergone open hernial sac high ligation surgery due to misdiagnosis as indirect hernia, resulting in recurrent groin bulges postoperatively. For these cases, laparoscopic direct hernia neck ligation with reinforcement and repair using the inner side of the umbilical ligament was performed. Results: All 10 cases of pediatric patients underwent surgeries smoothly without any need for open conversion. The average surgical duration was 29.8 ± 15.0 minutes, with minimal intraoperative bleeding. Patients were discharged on the first day postoperatively, and no significant surgery-related complications were observed. During the 12-month follow-up period, it was noted that the scar at the umbilical ring was superficial and inconspicuous. There were no occurrences of hernia recurrence, testicular retraction, or atrophy. Conclusion: Laparoscopic treatment for pediatric direct inguinal hernia has demonstrated favorable therapeutic outcomes, ensuring a safe surgical process, rapid recovery, and a low postoperative recurrence rate. The laparoscopic approach, specifically utilizing direct hernia neck ligation with reinforcement and repair using the inner side of the umbilical ligament, proves to be a secure and effective treatment for pediatric direct inguinal hernia. It can be considered as a conventional treatment method.

A single-centre, retrospective study of incisional hernia repair outcomes post kidney transplantation.

Incisional hernias (IH) after kidney transplantation (KTx) can cause significant morbidity in kidney transplant recipients (KTR). We aimed to report the outcomes of surgical repair of IH in KTR from our centre. We retrospectively analysed all the IH repairs in KTR from May 2018 to May 2023. We documented pre-transplant baseline characteristics, peri- and post-KTx events and outcomes and post-IH repair complications. We also documented length of stay, survival, and hernia recurrence post-IH repair. We performed 35 incisional hernia repairs in 34 KTR from May 2018 to May 2023 with an overall incidence of 1.63% symptomatic IH. Mean patient age was 56.7 ± 10.1 years and mean body mass index (BMI) 29.7 ± 6.49kg/m2. A history of previous hernia operation and open abdominal operations was present in 11.4% and 22.9% of the population, respectively. The types of repairs performed were primary (5.7%), onlay (62.9%), inlay (2.9%) and retromuscular sublay (28.6%). Mean hernia neck size was 8.9 ± 5.6cm. After IH repair, there was no perioperative mortality with an average 5.5 ± 3.9 days of length of stay. There were seven episodes (20%) of IH recurrence. There was a 6% of superficial wound dehiscence rate and a 3% of surgical site infection. Pearson's correlation test revealed that post-operative hernia recurrence was not related with neck size, post-transplant complications or pre- and post-transplant characteristics, as well as post-transplant outcome. The recurrence rate in our cohort was 20%. Known risk factors for IH in KTR as well as post-KTx events were not correlated with hernia recurrence or other post-hernia repair complications.

Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias

PurposeInguinal hernias are mainly diagnosed clinically, but imaging can aid in equivocal cases or for treatment planning. The purpose of this study was to evaluate the diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias.MethodsThis single-center retrospective study reviewed all consecutive Valsalva-CT studies between 2018 and 2019. A composite clinical reference standard including surgery was used. Three blinded, independent readers (readers 1–3) reviewed the CT images and scored the presence and type of inguinal hernia. A fourth reader measured hernia size. Interreader agreement was quantified with Krippendorff’s α coefficients. Sensitivity, specificity, and accuracy of Valsalva-CT for the detection of inguinal hernias was computed for each reader.ResultsThe final study population included 351 patients (99 women) with median age 52.2 years (interquartile range (IQR), 47.2, 68.9). A total of 381 inguinal hernias were present in 221 patients. Sensitivity, specificity, and accuracy were 85.8%, 98.1%, and 91.5% for reader 1, 72.7%, 92.5%, and 81.8% for reader 2, and 68.2%, 96.3%, and 81.1% for reader 3. Hernia neck size was significantly larger in cases correctly detected by all three readers (19.0 mm, IQR 13, 25), compared to those missed by all readers (7.0 mm, IQR, 5, 9; p < 0.001). Interreader agreement was substantial (α = 0.723) for the diagnosis of hernia and moderate (α = 0.522) for the type of hernia.ConclusionValsalva-CT shows very high specificity and high accuracy for the diagnosis of inguinal hernia. Sensitivity is only moderate which is associated with missed smaller hernias.

Parastomal hernia containing the stomach—a rare complication

Abstract A lady in her 70s presented to hospital with sudden onset nausea and excessive vomiting. She had a constant and worsening abdominal pain that radiated to the back but was focused on her stoma in the left iliac fossa. The patient had bilateral hernias and colostomy following a Hartman’s procedure for perforated diverticulosis in 2018 and had presented twice before in the last 6 months with similar symptoms. CT abdomen pelvis showed a large portion of the stomach in the parastomal hernia leading to a narrowing of the stomach at the hernia neck but no ischaemic changes. She was diagnosed with bowel obstruction and successfully treated with fluid resuscitation, proton pump inhibitors, analgesia, antiemetics and decompression of the stomach using large bore nasogastric tube. A total of 2600 ml fluid was aspirated in 24 h and her stoma restarted normal output. After 10 days she was discharged home.

Strangulated giant inguinal scrotal hernia with traction perforation at lesser curve of the stomach

A giant inguinoscrotal hernia is typically associated with a low risk of bowel obstruction or strangulation. When the hernia is complicated with acute gastric perforation, it is an exceedingly rare clinical entity. The operative strategy may be definitive at the index surgery or staged. The technical challenge is the severity of the peritoneal contamination contradicting mesh placement, coupled with the loss of domain. Herein we report a 58-year-old man with a long-standing right giant inguinoscrotal hernia, who presented with strangulation with a 1 day history. An urgent midline laparotomy access revealed a large tear over the lesser curvature of the stomach, attributable to choking at the hernia neck. Furthermore, there was severe contamination with total bowels herniation into the sac. We performed a complete reduction of hernia content, primary repair of stomach perforation, and primary closure of midline access and hernia neck repair with posterior wall reinforcement using prolene via an inguinal incision. The patient made an uneventful recovery and was discharged well. The perioperative clinical events and technical strategies are discussed in the current report.

P-049 DAMAGE CONTROL SURGERY FOR AN INCARCERATED GIANT UMBILICAL HERNIA IN A SUPEROBESE PATIENT

Abstract Aim To report the case of the emergency management of an incarcerated giant umbilical hernia in a superobese patient with a damage control surgery as the first step for its treatment. Material &amp; Methods We present the case of a 47-year-old man with a BMI of 62 kg/m2 who arrived to the emergency department for abdominal pain. Examination and CT scan revealed a giant umbilical incarcerated hernia with loss of domain, with an 8 cm hernia neck and containing the entire bowel except for the rectosigmoid and duodenum. Results The emergency managment was a laparotomy with a subcutaneous right lateral approach, opening first the hernia sac to verify bowel viability. Then, we performed a tranverse chelotomy on the right side of the defect, leaving the defect open and wider to prevent hernia strangulation. We left two drains in the subcutaneuos space and the wound was covered with vacuum therapy dressing. The patient recovery was uneventful and he was discharged in the sixth postoperative day. After this episode the patient started a very strict weight loss treatment, so we coul plan the final wall reconstruction surgery, which hasn't already been performed, but which will include botulinum toxin and progressive preoperative pneumoperitoneum. Conclusions We belive that damage control surgery was the most appropiate option as the first step for the management of an incarcerated complex hernia, so in a second time an elective complex wall reconstruction surgery could be performed.

HERNIA SAC NECK RATIO - A TOOL TO PREDICT THE DEVELOPMENT OF SYMPTOMS AND COMPLICATIONS IN UMBILICAL HERNIA

BACKGROUND: An umbilical hernia with a narrow neck and a wide sac is more prone to complications, thus the morphology of an umbilical hernia is crucial in determining the development of symptoms and consequences. The hernia sac-neck ratio and ultrasonographic ndings are used in this study to take into account the physical properties of the hernia in order to anticipate the onset of symptoms and complications. MATERIALS AND METHODS: This study is a prospective observational study conducted in Victoria Hospital from February 2021 to July 2022.Atotal of 115 patients with umbilical hernia underwent an ultrasound of abdomen to note the size of the neck of the hernia. The diameter of the hernia sac was measured clinically for both emergency and elective patients intra-operatively. The ratio was calculated and compared. RESULTS: The 115 research participants included 52 complicated cases and 63 uncomplicated cases. The mean hernia neck size in complicated case was 2.07 cm and in uncomplicated group was 2.53 cm. According to the ROC curve analysis, the mean hernia sac neck ratio, the study's area of interest, was higher in the complicated group than in the uncomplicated group (2.78 vs. 2.42) and was linked with a 49% sensitivity and 70% specicity at a cutoff ratio of 2.6. CONCLUSION: This study showed that the Hernia sac neck can be used as a specic tool for predicting complications and that individuals with a smaller neck and a bigger sac are more likely to have complications.

Hernia-to-neck ratio is associated with emergent ventral hernia repair.

The ratio of hernia size to fascial defect size, termed the hernia-to-neck ratio (HNR), has been proposed as a novel predictive factor for umbilical hernia complications. HNR ≥ 2.5 has been suggested to warrant surgery due to association with bowel strangulation, incarceration, and necrosis. The aim of this study was to evaluate the association between HNR and emergent ventral hernia repair at our institution. A retrospective cohort study was performed of consecutive patients with ventral hernias evaluated at a large safety-net hospital from 2017 to 2019. Patients who required emergent ventral hernia repair were compared to patients who did not require repair at latest follow-up. HNR was calculated using a previously described method: maximal hernia sac size and maximal fascial defect size (termed "hernia neck size") were measured in the sagittal plane on CT scan. Data are described as mean ± standard deviation and median (interquartile range). A total of 166 patients were included: 84 (51%) required emergent hernia repair and 82 (49%) did not undergo repair. Median follow-up was 19 (8-27) months. Patient groups were similar except the emergent repair group had more males (50% vs. 34%, p = 0.03), umbilical hernias (93% vs. 56%, p < 0.01), recurrent hernias (31% vs. 15%, p < 0.01), and lower mean BMI (34.3 ± 9.9 vs. 39.1 ± 6.5, p < 0.01). Hernia sac size did not differ between groups (5.8 [3.8-8.4] cm vs. 6.1 [3.5-11.8] cm, p = 0.45). Hernia neck size was significantly smaller in the emergent repair group (1.5 [2.3-3.5] cm vs. 3.4 [1.8-6.2] cm, p < 0.01). Hernia-to-neck ratio was significantly higher in the emergent repair group (2.4 [1.8-3.1] vs. 1.7 [1.1-2.9], p < 0.01). This study demonstrated an association between higher HNR and increased risk of emergent ventral hernia repair. Future studies will evaluate the use of HNR to risk-stratify patients with ventral hernias in a safety-net hospital.

Inferior Lumbar Hernia: A Case Report and Review of the Literature

Primary lumbar hernias are a rare; two types are described, according to the anatomical location of the hernia neck and etiology: the inferior and the posterior. While they are more lessely located within the inferior lumbar triangle. Incarceration is uncommon but represents a surgical emergency when present. We presente a case of 68-year-old-woman had an inferior lumbar hernia unexpectedly discovered during an evaluation of the extent of locoregional colorectal adenocarcinoma. Abdominal CT scan demonstrated herniation of small bowel though the inferior lumbar triangle. CT scan is useful to distinguish hernia from solid mass, abscess, or other pathology, while bedside ultrasound may prompt an attempt at immediate reduction. Furthermore, CT provided the vital role in prompting surgical management. CT is now widely accepted as the imaging modality of choice for lumbar hernia, principally for its role in defining hernia contents accurately. Surgical correction is always more difficult in advanced cases, surgery must be indicated as early as possible. Surgical treatment can be performed as either an open or laparoscopic procedure with equivalent success.

Giant Inguinoscrotal hernia -a radiological perspective

Inguinal hernia is a common surgical disease. Giant inguinoscrotal hernias are more unusual and impose significant impact on quality of life including difficulty with mobility, scrotal skin ulceration and bowel obstruction. Besides it is more challenging in terms of surgical management. Diagnosis of giant inguinoscrotal hernia is straight forward on clinical examination. Nevertheless, with the advent of CT scan, pre-operative contrast-enhanced CT scan is useful for ascertaining the hernia contents, its configuration and measuring the neck of hernia. We report a case of a patient with extremely huge irreducible right giant inguinoscrotal hernias.

MDCT imaging in Spigelian hernia, clinical, and surgical implications

ObjectiveSpigelian hernia is an uncommon congenital or acquired defect in the transversus abdominis aponeurosis with non-specific symptoms posing a diagnostic challenge. There is a paucity of radiology literature on imaging findings of Spigelian hernia. The objective of this study is to explore the role of MDCT in evaluating Spigelian hernia along with clinical and surgical implications. Materials and methodsIn this IRB approved, HIPAA compliant retrospective observational analysis MDCT imaging findings of 43 Spigelian hernias were evaluated by two fellowship-trained radiologists. Imaging features evaluated were: presence of Spigelian hernia, laterality, relation to “hernia belt” (between 0 and 6 cm cranial to an imaginary axial line between both anterior superior iliac spines), the hernia neck and sac sizes, hernia content, and other coexistent hernias (umbilical, incisional, inguinal). Patient's demographics (age, gender, BMI, conditions with increased intra-abdominal pressure) were also recorded for any correlation. Results60% (26/43) of Spigelian hernias were located below the hernia belt while 33% (14/43) within the hernia belt and 7% (3/43) above the hernia belt. The most common subtype of Spigelian hernia encountered was interparietal (84%). The mean hernia neck diameter was 3.4 cm, mean hernia sac volume was 329 cc. Hernia content included: fat (43/43) bowel (23/43), fluid (3/43). 3 patients had no clinical history provided, the remaining 37 patients' clinical presentation was asymptomatic in 73% (27/37), acute abdominal pain in 5% (2/37) and chronic abdominal pain in 22% (8/37). None of the hernia were incarcerated and none of the patients underwent emergent surgery. No significant correlation was noted between Spigelian hernia and causes of increased intra-abdominal pressure. 90% of our patients had other abdominal hernias. 30.9 was the mean BMI (20.8–69.1). ConclusionMost of the Spigelian hernia occurred below the traditionally described hernia belt and the majority are of interparietal subtype that can be best diagnosed with MDCT in contrast to physical examination.

Computed Tomography Image Analysis in Abdominal Wall Reconstruction: A Systematic Review.

Background:Ventral hernias are a complex and costly burden to the health care system. Although preoperative radiologic imaging is commonly performed, the plethora of anatomic features present and available in routine imaging are seldomly quantified and integrated into patient selection, preoperative risk stratification, and perioperative planning. We herein aimed to critically examine the current state of computed tomography feature application in predicting surgical outcomes.Methods:A systematic review was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) checklist. PubMed, MEDLINE, and Embase databases were reviewed under search syntax “computed tomography imaging” and “abdominal hernia” for papers published between 2000 and 2020.Results:Of the initial 1922 studies, 12 papers met inclusion and exclusion criteria. The most frequently used radiologic features were hernia volume (n = 9), subcutaneous fat volume (n = 5), and defect size (n = 8). Outcomes included both complications and need for surgical intervention. Median area under the curve (AUC) and odds ratio were 0.68 (±0.16) and 1.12 (±0.39), respectively. The best predictive feature was hernia neck ratio > 2.5 (AUC 0.903).Conclusions:Computed tomography feature selection offers hernia surgeons an opportunity to identify, quantify, and integrate routinely available morphologic tissue features into preoperative decision-making. Despite being in its early stages, future surgeons and researchers will soon be able to integrate 3D volumetric analysis and complex machine learning and neural network models to improvement patient care.

Signs and landmarks in eTEP Rives-Stoppa repair of ventral hernias.

After years of playing second-fiddle to laparoscopic underlay repairs, the retro-muscular Rives-Stoppa repair is rapidly gaining popularity thanks to the endoscopic eTEP approach. It extends all the advantages of a retro-muscular mesh placement-increased tolerance for infection, mechanical robustness, reduced need for mesh fixation-in an ergonomically acceptable system. The eTEP technique described by Belyansky's group requires a "crossover" from one retro-rectus space to the other. The aim of the crossover is to safely amalgamate the retro-rectus spaces for placement of a large extra-peritoneal prosthesis. By salvaging peritoneum in the midline and operating in the extra-peritoneal plane, one can avoid large defects in the posterior rectus sheath (PRS)-peritoneum complex which need closure. Correct identification of anatomical landmarks is imperative to safely perform the surgery. The "lamppost sign" signals the lateral limit of retro-rectus dissection, preventing iatrogenic injury to the neurovascular bundles and linea semilunaris. After crossover has been safely achieved, the medial edges of the divided posterior rectus sheaths are found connected to each other by a strip of pre-peritoneal fat and peritoneum in the midline. These structures, along with the neck of hernia constitute the "volcano sign". For inferior defects, the vas deferens, the inferior epigastric and gonadal vessels form a triradiate conformation termed the "Mercedes-Benz sign". These signs serve as tools to identify the composition of the surgical field, avoiding iatrogenic injury to the linea alba and linea semilunaris, while reducing the time taken for posterior closure.

The role of umbilical hernia sac neck ratio in predicting the development of symptoms and complications

Background: The morphology of an umbilical hernia is important in deciding the course of symptoms and complications as a hernia with a narrow neck and a large sac is more prone to complications. At present there are no fixed guidelines on when to operate on an umbilical hernia. This study considers the morphological characteristics of the hernia using the hernia sac-neck ratio and an ultrasound as a non invasive tool in predicting the development of symptoms and complications. Methods: This study is a DESCREPTIVE/OBSERVATIONAL study conducted at JSS HOSPITAL MYSORE from November 2017 to December 2019. For All cases presenting to JSS hospital with an umbilical hernia an ultrasound abdomen was performed to note the size of the neck of the hernia. The diameter of the hernia was measured clinically and the required ratio calculated.Results: Out of the 50 patients in the study 40 were complicated and 10 uncomplicated. the mean hernia neck size in the complicated group was 2.02 cm with a P value of 0.091 un complicated group which is 2.95 cm. The mean hernia sac neck ratio which is the area of interest in this study was more in the complicated group at 2.97 and much lesser in the uncomplicated group at 2.02 and based on the ROC curve analysis at cut off ratio of 2.2 was associated with a 90% sensitivity and a 70% specificity.Conclusion: This study concludes that patients with a smaller neck and a larger sac are more prone to develop complications and the Hernia sac neck ratio can be used as a sensitive tool in predicting the same.

NOONAN SYNDROME WITH MULTIPLE GIANT CELL LESIONS, CASE REPORT

Noonan syndrome with multiple giant cell lesions (NS/MGCLS) is a term used to describe a subgroup of people with Noonan syndrome, a rare condition with phenotypic overlap with NS. Once thought to be a specific and separate entity, it is now suggested to be a variant of the NS spectrum. Here we report a 22-year-old patient misdiagnosed as having Rubinstein-Taybi syndrome (microcephaly, congenital heart disease, ventricular septal defect, cryptorchidism, pterygium coli, inguinal hernia, and short stature and neck). He had multiple dental retentions; therefore, a cone beam computed tomography was requested, which showed multiples radiolucent lesions of both sides of the jaw. An excisional biopsy of larger lesion was performed, and the results indicated giant cell granuloma. Patient was referred to the Genetics department because of suspicion of Noonan syndrome, which was confirmed after molecular study. Postoperative control shows bone formation in treated lesion on the right side and growth of the lesion on the left side.

Laparoscopic umbilical herniorrhaphy: a novel technique of hernia neck closure and outcomes in the first 19 cases

Background: Laparoscopicrepair of umbilical hernias are still in its infancy and we present a newapproach to an old problem. Methods: Laparoscopicrepair of umbilical hernias were performed on 19 patients in which the hernianeck was addressed by suturing it closed with a non-absorbable suture and thenapplying an underlay mesh. Data was obtained from operative reports and thesurgeon’s electronic medical records (EMRs). All surgeries were performed by asingle surgeon in a rural hospital in northern Saskatchewan. Results: The resultsshowed no hernia recurrences over a two year follow up.88 percent of patientswere male with BMIs in the range of 22.6–45.3. Six patients had more than 1hernia and the average operative time was 84.75 minutes. Conclusions: Laparoscopicumbilical herniorrhaphy with intra corporeal neck closure is a viable form ofhernia repair. None of the patients presented with umbilical wound infectionsdue to the lack of an incision at the umbilicus. There were also good cosmeticresults due to the reapproximation of the subcutaneous tissue resulting in theformation of a new umbilicus without the obvious scar and deformation oftenassociated with an open repair. A randomised trial is now required as well alonger follow up to determine the efficacy of this technique. The outcomes inthe first 19 patients show a novel technique for umbilical herniorrhaphy whichin the era of laparoscopic surgery we hope will add to the surgicalarmamentarium.

CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings.

The objective of this study was to identify CT findings and determine interobserver reliability of surgically proven gastric volvulus. This single-center retrospective study included 30 patients (21 women, nine men; mean age, 73 years old) with surgically proven gastric volvulus who underwent preoperative CT and 31 age- and sex-matched control subjects (21 women, nine men; mean age, 74 years old) with large hiatal hernias who were imaged for reasons other than abdominal pain. Two blinded radiologists reviewed the CT images and recorded findings of organoaxial and mesenteroaxial gastric volvulus and ischemia. Interobserver reliability, reader accuracy, sensitivity, specificity, and likelihood ratios of each CT finding were calculated. The radiologists were overall 90% accurate (55/61; six false-negatives per reader) in identifying gastric volvulus. Interobserver agreement was substantial (κ = 0.71) for identifying the presence or absence of gastric volvulus. Agreement for most CT findings of gastric volvulus (11/14, 79%) was excellent (5/14, 36%) or substantial (6/14, 43%); the remaining findings showed moderate agreement (3/14, 21%). The most frequent and sensitive CT findings of volvulus with high positive likelihood ratios were stenosis at the hernia neck (reader 1, sensitivity = 80%, positive likelihood ratio = 26.66; reader 2, sensitivity = 77%, positive likelihood ratio = 12.83) and transition point at the pylorus (reader 1, sensitivity = 80%, positive likelihood ratio = 17; reader 2, sensitivity = 70%, positive likelihood ratio = 15). The presence of perigastric fluid or a pleural effusion were significantly more frequent in patients with ischemia at surgical pathology (p < 0.05 in all comparisons, both radiologists). In our series, CT showed substantial interobserver agreement and fair accuracy in identifying the presence of gastric volvulus.

Case of a strangulated right paraduodenal fossa hernia in a malrotated gut

We report an unusual case of a strangulated internal hernia resulting from a right paraduodenal fossa hernia (PDH) in the context of bowel malrotation. There are few documented cases of...

Strangulation and necrosis of right hemicolon as an extremely rare complication of Spigelian hernia.

Strangulation and necrosis of right hemicolon as an extremely rare complication of Spigelian hernia.

Dynamic power Doppler ultrasonography of anterior abdominal wall hernias: confirmation of incarceration.

Power Doppler ultrasonography (PD-US) is a motion-sensitive modality that can display flow characteristics regardless of the direction. This increased motion sensitivity can be used as a parameter to show the tissue motion on artificially generated fremitus images. This study aimed to confirm any signs of incarceration in abdominal wall hernias proven by herniorrhaphy by examination with dynamic PD-US (during manual compression-decompression maneuvers). Twenty-seven patients with anterior abdominal wall hernia with a narrow neck (<1cm in diameter) were examined firstly with gray-scale ultrasonography (GS-US), and then with dynamic PD-US. Two independent radiologists, who were blinded to the real-time images showing the orientation and motion of the hernia neck, completed the examinations. These images were evaluated for any signs of incarceration, as well as the orientation of the hernia neck. Orientations of the hernia neck were not described on GS-US images in 13 lesions and on dynamic PD-US images in 3 lesions. While the GS-US examination revealed incarcerated hernia in four of the patients, the dynamic PD-US examination revealed an additional seven patients with symptoms associated with incarceration. Dynamic PD-US may show the orientation of the hernia neck and any sign of incarceration more accurately and clearly than conventional GS-US. Being informed about these features preoperatively is of utmost importance. Thus, anterior abdominal wall hernias should be examined by dynamic PD-US.