In Reply We appreciate the comments and insight Dr Aanning shared regarding our study.1 Dr Aanning recommended repeating the baseline computed tomographic (CT) scan with the patient performing the Valsalva maneuver. Previous studies have suggested that the Valsalva maneuver can increase confidence in the diagnosis by making clinically suspected hernias more obvious and can decrease false negatives due to hernias previously undetected on CT scans with the patient at rest.2,3 Despite this, the radiologists still had limited agreement (κ = 0.72), which suggests that they did not agree on 30% of cases. In addition, the CT scans with the patients performing the Valsalva maneuver were not correlated with the results of clinical examinations or operative findings. Although it is biologically plausible that a CT scan with the patient performing the Valsalva maneuver could improve the interobserver agreement, additional studies are needed. Furthermore, as our study demonstrates, multidisciplinary collaboration between surgeons and radiologists is necessary to optimize imaging techniques and their interpretation and to improve patient outcomes.
Julie L. Holihan, Lillian S. Kao, Mike K. Liang. Computed Tomography and Ventral Hernia Recurrence—Reply. JAMA Surg. 2016;151(5):492–493. doi:10.1001/jamasurg.2015.4892