Objective To explore the application of ultrasonic volume auto-scan (UVAS) in the classification, diagnosis, and treatment of abdominal incisional hernia. Methods Using a prospective, randomized, and single-blind study design, The study subjects were 46 elderly patients with abdominal wall incisional hernia recruited from the Department of Hernia and Abdominal Wall Surgery, Huadong Hospital Affiliated to Fudan University, from August 2023 to December 2024. totally 56 abdominal wall defects (hernia rings), were recruited based on inclusion criteria. UVAS was employed to measure the width, area, and hernia sac volume (HSV) of the hernia rings. The consistency between these measurements and the HSV determined by CT was evaluated. Additionally, the ultrasound-based classification diagnosis of incisional hernia was compared with the surgical diagnosis. Results The average ratio of UVAS and CT measurements for HSV values was 1.007, which was close to 1. Only 1.79% (1/56) of the points fall outside the 95% consistency bounds 0.997-1.026, which showed good consistency between the two methods in measuring HSV. Based on the location and width of the abdominal wall defect, UVAS preoperative classification diagnosis showed a good accuracy rate (94.6%, 98.2%), achieving good consistency with postoperative diagnosis (K=0.86, 95%CI 0.718-0.996; K=0.95, 95%CI 0.887-0.999). In large and giant incisional hernias, the mesh size is 2 to 9 times the area of the abdominal wall defect measured by UVAS. Conclusion UVAS could accurately diagnose and measure the width, area, and HSV of abdominal incisional hernia, perform preoperative classification and localization, have the advantages of no radiation hazard and instant report provision and provide detailed and reliable data and imaging information for comprehensive preoperative evaluation of elderly patients with incisional hernia.