Laparoskopischer Bruchlückenverschluss bei Appendizitis im Leistenhernienbruchsack (Amyand-Hernie): Ist der Einsatz eines Netzes kontraindiziert?

Abstract

Amyand's hernia is defined as an appendix vermiformis - inflamed or not - within the hernia sac at the ipsilateral groin. The occurrence of this specific type of hernia is extremely low; clinical presentation is preoperatively characterised by signs and symptoms of an incarcerated inguinal hernia. There is a controversial debate on the use of prosthetic material for mesh-based hernioplasty; actually, the majority of surgeons reject it. However, in the area of predominantly prosthetic hernioplasty, this question has been raised again. Based on the approximately 150 published cases so far and their detailed analysis, this controversial issue in Amyand's hernia is reassessed, also on the basis of our own clinical experience in the treatment of two representative cases. Even in the case of a coincident finding of appendicitis within the sac of an inguinal hernia, laparoscopic hernioplasty using alloplastic meshes appears possible after simultaneous appendectomy if, in addition, the adhesive hernia sac is also resected. If prosthetic material is implanted, only low weight and large-porous meshes should be used.