Amyand′s hernia: Our experience in the laparoscopic era

Abstract

Amyand's hernia is a rare presentation of inguinal hernia, in which the appendix is present within the hernia sac. This entity is a diagnostic challenge due to its rarity and vague clinical presentation. A laparoscopic approach can confirm the diagnosis as well as serve as a therapeutic tool. When the appendix is not inflamed within the inguinal hernia sac, then appendicectomy is not always necessary. Our case series emphasize the same presumption as three patient of Amyand's hernia underwent laparoscopic transabdominal preperitoneal hernioplasty without appendicectomy. The aim of this paper is to review the literature with regards to Amyand's hernia and provide new insight in its diagnosis and treatment.

Normal Appendix in the Elective Inguinal Hernia Repair: Case Report and Review of Literature

“…One report described a laparoscopic approach in three clinical cases and they performed mesh hernioplasty without appendectomy in all of the patients. 22 Intraoperative findings in these cases revealed the presence of the vermiform appendix in 30 cases, sometimes accompanied by the cecum in nine cases and a small bowel loop in two cases. Twenty-eight appendices were described as normal, while four had slight oedema, and three presented adherences to the hernia sac.…”

“…In all cases appendix looked mildly congested without gross evidence of inflammation, so no appendectomy was done. 22 The authors argue that hernia repair with mesh should be the main goal and that latter appendectomy can always be addressed laparoscopically again. The first case of Amyand's hernia with inflamed appendix that was repaired laparoscopically was reported in 1999.…”

Appendectomy or not in middle-aged male with non-inflamed appendix in Amyand’s hernia? Case report and literature review

“…CT is highly sensitive and specific in diagnosing acute appendicitis, but the use of both CT and US for the diagnosis of Amyand’s hernia is an area of debate [ 1 , 3 , 6 ]. Vermillion et al reported the first laparoscopic Amyand’s hernia reduction in 1999 and others have reported this approach [ 14 , 15 ]. In our case the pre-operative CT scan ordered by the Primary Care Physician allowed us to determine a likely Amyand’s type 1 hernia and to plan a laparoscopic approach with a trans-abdominal pre-peritoneal hernia repair with prosthetic mesh.…”

Laparoscopic repair of Amyand’s hernia complicated with acute appendicitis. Report of a case

“…Amyand’s hernia was first described by Claudius Amyand in 1735 [2]. It can occur at any age, mostly in men and is three times more common in children than in adults [3, 4]. The pathophysiology of this rare condition is unknown, but the most common explanation is that the vermiform appendix herniates through a patent processus vaginalis.…”

“…Acute appendicitis, as in this case, is reported in only 0.08-0.013% of cases and usually clinical presentation of Amyand’s hernia mimics that of an incarcerated inguinal hernia [2]. Majority of patients present to the emergency department with non-specific signs or symptoms, thus making the clinical diagnosis challenging, if not impossible [4].…”