Endoscopic total extraperitoneal management of Amyand's hernia

De Garengeot hernia: laparoscopic treatment in emergency

Introduction: De Garengeot Hernia is described as the presence of an appendix within a femoral hernia. Case Report: We report the case of an elderly woman, who presented with incarcerated femoral hernia without signs of bowel obstruction. CT showed a femoral hernia with appendix in the femoral canal with signs of strangulation. the patient underwent emergency surgery. Diagnostic laparoscopy revelead a non-reducible appendix in the femoral canal, in the absence of signs of peritonitis. An infrainguinal incision was performed. An gangrenous appendix within the sac was revealed, detached from the sac and reintroduced into the abdomen through the femoral canal. The laparoscopic appendectomy was then performed. The hernia repair was performed by suturing the iliopubic tract to Cooper’s ligament. Patient had a regular course. Discussion: De Garengeot’s hernia is a rare occurrence. After the year 2000 a total of 32articles, wich presented 34 cases of de Garengeot’s hernia have been published. Due to the rarity of this disease there is not standard procedure; laparoscopy may be a valid technique for determining the condition of the hernia, but due to the difficulty of preoperative diagnosis it is unlikely to be the first choice for the surgical approach. The use of CT can therefore be decisive to help the surgeon in the choice of the approach. Conclusion: De Garengeot’s hernia can be approached in urgent laparoscopy even in the complicated forms of appendicular inflammation. (www.actabiomedica.it)

Simultaneous laparoscopic total extraperitoneal inguinal hernia repair and laparoscopic appendectomy for Amyand's hernia: a case report

Background

An Amyand’s hernia is defined by the presence of a vermiform appendix within an inguinal hernia sac. Most of these cases are not diagnosed preoperatively and the surgical approach is dependent on the type present and associated intraoperative findings. We present a case of a preoperatively diagnosed Amyand’s hernia in a man who underwent treatment by simultaneous laparoscopic totally extraperitoneal repair and laparoscopic appendectomy.

Case presentation

We encountered the case of a 76-year-old Japanese man with a right inguinal pain. Ultrasound and computed tomography confirmed his vermiform appendix herniated into the right inguinal canal. We managed a simultaneous laparoscopic total extraperitoneal inguinal hernia repair with mesh and laparoscopic appendectomy. He was discharged without any postoperative morbidity.

Conclusions

We recommend laparoscopic appendectomy and totally extraperitoneal hernia repair with mesh after laparoscopic reduction for Amyand’s hernia.

A total laparoscopic treatment strategy for Amyand's hernia complicated with appendicitis: A case report

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An appendix incarcerated in the inguinal hernia is defined as Amyand’s hernia.

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Preoperative diagnosis of Amyand’s hernia is feasible with ultrasound and CT.

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Laparoscopy for diagnostic and therapeutic purposes has been on an upward trajectory.

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A potential total laparoscopy treatment strategy for Amyand’s hernia was proposed, with fair outcomes.

Introduction

The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand’s hernia. It is even rarer with complicated appendicitis. Formerly it was treated via an open groin approach; recently there are new trends involving the use of laparoscopy for reduction and management of appendix. Conversely the role of laparoscopy in the following hernia repair was less discussed, with no standard care. We reported a case of Amyand’s hernia complicated with appendix which was managed via a total laparoscopic strategy.

Presentation of case

A 49-year-old male presented with right groin mass with progressive pain for 3 days. Physical exams revealed incarcerated right inguinal hernia. Amyand's hernia with acute appendicitis was diagnosed preoperatively via computed tomography (CT). Emergent diagnostic laparoscopy was performed. Appendix was reduced, with appendectomy justified for signs of appendicitis. An interval total extraperitoneal (TEP) hernioplasty was performed 3 month later, with no adverse events postoperatively.

Discussion

In virtue of previous literature, we proposed a total laparoscopic strategy for Amyand’s hernia which consists of transabdominal diagnostic laparoscopy, management of appendix, and either immediate or elective laparoscopic hernioplasty, based on status of appendix.

Conclusion

This laparoscopic treatment strategy is feasible for Amyand’s hernia, with minimized risk of surgical site infection (SSI), fair recovery and cosmesis.

Appendiceal perforation, necrotizing groin infection and spermatic cord necrosis in a case of Amyand's hernia

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Amyand’s hernias are an uncommon variant of inguinal hernia.

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Early recognition of this hernia type may improve patient care and outcome.

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Treatment for Amyand's hernias is dictated by additional factors, which has led to a classification scheme.

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There is no consensus on the approach to repair of these hernias but various described approaches have shown success.

Introduction

Inguinal hernias containing the appendix are described as Amyand’s hernias. The surgical approach to these types of hernias is dependent on the type present and associated intra-operative findings.

Presentation of case

We present a case of complicated type IV Amyand’s hernia, which was managed though combined abdominal and inguinal approach. Though the patient had a prolonged post-operative course due to pulmonary embolism, he progressed to full recovery.

Discussion

The different grades of Amyand’s hernia are repaired in varying ways, including laparoscopic and open approaches with or without mesh. The type of repair must be tailored to the patient and disease process.

Conclusion

Primary repair of a perforated Amyand’s hernia provides adequate strength with decreased risk of infection due to synthetic material.

Amyand's Hernia with Appendicitis: A Case Report and Integrative Review

Introduction. Inguinal hernia is a common disorder with an estimated prevalence of 1.2% of the entire population and it is 12 times more common in males. Objective. To describe a case of appendix with signs of inflammation in the hernia sac, condition that is rare and difficult to diagnose, and to perform literature review, describing the most relevant aspects and the main controversies. Method. Report of a case and search in PubMed on June 1, 2015, using the terms “Appendix” [MeSH term] AND “hernia, inguinal” [MeSH term]. Results. The search resulted in 38 articles in total, and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Discussion. The search resulted in a total of 38 articles and after deleting the articles that were not part of the inclusion criteria, there were 26 case reports remaining. Conclusion. Amyand's hernia is a rare and difficult to diagnose condition, being commonly found occasionally in surgical procedures. It should be remembered in the presence of cases of incarcerated hernia, due to its possible complications if not diagnosed.

Amyand's hernia: Our experience in the laparoscopic era

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.

Amyand's hernia: a review

BACKGROUND

The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. The aim of this systematic review was to gather information concerning its prevalence, clinical image, diagnosis, and treatment.

DATA SOURCES

The MEDLINE database was thoroughly searched using the keyword "Amyand's hernia." Additional articles were gathered and evaluated.

CONCLUSIONS

The true prevalence of Amyand's hernia seems lower than classically described. Its usual clinical image is identical to that of an incarcerated hernia, and thus it is almost impossible to diagnose preoperatively, although ultrasound and computed tomography can help. Treatment includes hernioplasty with or without appendectomy and/or mesh repair depending on the vermiform appendix's inflammation status, the patient's general condition, and other factors. Amyand's hernia generally has a good prognosis, although serious complications have been described. Surgeons should be prepared if they encounter Amyand's hernia because appropriate treatment ensures hernia repair without complications and with avoidance of recurrence.

Amyand's hernia: a review

Amyand’s hernia is defined as when the appendix is trapped within an inguinal hernia. While the incidence of this type of hernia is rare, the appendix may become incarcerated within Amyand’s hernia and lead to further complications such as strangulation and perforation. Incarceration of the appendix most commonly occurs within inguinal and femoral hernias, but may arise to a lesser extent in incisional and umbilical hernias. Incarcerated appendix has been reported in a variety of ventral abdominal and inguinal locations, yet its indistinct clinical presentation represents a diagnostic challenge. This paper reviews the literature on incarceration of the appendix within inguinal hernias and discusses current approaches to diagnosis and treatment of Amyand’s hernia and complications that may arise from incarceration of the appendix within the hernia.

Amyand's Hernia: Study of four cases and literature review

The presence of the appendix in an inguinal hernial sac is described as Amyand's hernia. It is a rare entity which presents mostly at the exploration of the inguinal canal. The appendix may be apparently normal or have all the features of acute appendicitis with its possible complications. We report four cases of Amyand's hernia which were treated at Sultan Qaboos University Hospital, Oman. All patients underwent appendectomy. In three cases, the inguinal hernia were repaired with Vipro mesh while, in the remaining case, a darning repair was done with Prolene sutures.

An incarcerated appendix: report of three cases and a review of the literature

We came across three rare cases of incarcerated hernia, with different presentations. The first case was an elderly female, who presented with an incarcerated incisional hernia on the right lower iliac region diagnosed on contrast enhanced computed tomography (CT); the contents were the small bowel and the perforated tip of the appendix. In the second case of inguinal incarcerated hernia, ultrasonography showed the inflammed appendix in the subcutaneous plane of the hernial sac, which is very rarely diagnosed pre-operatively and was confirmed during surgery. Inflammed appendix with gangrenous tip was found in the inguinal hernial sac. In yet another case of incarcerated inguinal hernia, the contents were a gangrenous part of the ascending colon and transverse colon, with the tip of the inflamed appendix--also only rarely observed. The colon extended to the scrotum in this case. We could find no description within the existing medical literature on either transverse or ascending colon as contents in inguinal hernia although transverse colon alone has been reported in four cases. The surgical options for dealing with the appendix in an Amyand's hernia depend on the mode of presentation. The presence of a normal appendix does not require an appendicectomy to be performed, but its removal is necessary if inflamed.

Amyand's hernia: a case report describing laparoscopic repair in a pediatric patient

Amyand's hernia is a rare hernia in which an incarcerated or perforated appendix is found in the right inguinal canal. This case report looks at the clinical presentation, the modalities for preoperative evaluation, and finally a combined approach of laparoscopic appendectomy and open repair of the hernia. To our knowledge, this is the first report of this type of management, and we feel that it is a safe and effective option.

Amyand Hernia: What Lies Beneath–A Proposed Classification Scheme to Determine Management

Acute appendicitis in a hernia sac occurs exceptionally. An 80-year-old male patient underwent emergency surgery for an incarcerated right inguinal hernia found to contain a gangrenous appendix. His brief improvement after an emergency herniotomy with appendectomy was followed by intestinal obstruction caused by advanced colon cancer. The unique features and individualized management of the four published types of Amyand hernia are reviewed. Rather than simply being an anatomical curiosity, Amyand hernias require individualized attention to decide how to manage both the appendix and the hernia. Clinical scrutiny, a high index of suspicion for surgical comorbidities, and a common sense approach may improve outcomes.

Review article: appendicitis in groin hernias

To review the clinical presentation, outcome and causes of acute appendicitis presenting within a groin hernia. A comprehensive review of the past 70 years of English language surgical literature was conducted pertaining to acute appendicitis presenting within an inguinal or femoral hernia. Thirty-four reports describing 45 patients were reviewed to determine age, position, gender, pathologic stage at presentation, causal suppositions, and clinical outcomes. Hernial appendicitis presented as an inguinal abscess or a tender inguinal mass, often in the femoral position, and most commonly at the extremes of age. It was almost never recognized preoperatively, and, because of the sequestered nature of the inflammatory process, presented with few classic systemic signs or symptoms suggestive of acute appendicitis. Advanced pathologic stage and death correlated with the patient's age, delay in presentation, and delay in recognition. Evaluation of an inguinal abscess or a nonreducible tender groin hernia presenting in a patient at the extremes of age, should include computed tomography to rule out an occult acute appendicitis within the hernia, as systemic signs and symptoms of appendicitis are rarely evident. The condition appears to be caused by inflammatory adhesions caused by appendicitis occurring within an enlarged hernial orifice rather than appendicitis caused by external compression of the appendix base. Early recognition of this unique presentation of appendicitis allows trans-hernial appendectomy and immediate herniorraphy. Delayed diagnosis requires drainage of abscess with appendectomy and interval hernia repair.

Amyand's hernia: a report of 18 consecutive patients over a 15-year period

AIM

The presence of a vermiform appendix in an inguinal hernia sac is termed Amyand's hernia. It may present as a tender inguinal or inguino-scrotal swelling and is often misdiagnosed as an incarcerated or strangulated hernia. The purpose of this study was to review the management of Amyand's hernia at a single institution since 1991.

MATERIAL AND METHODS

A retrospective analysis was undertaken of 18 consecutive patients with an Amyand's hernia operated upon at our institution from 1991 to 2005. Patients' demographics, treatment and postoperative outcome were analysed.

RESULTS

There were 17 men and one woman. Their median age was 42 years. None of the patients was diagnosed preoperatively. The commonest presenting symptom was painful inguinal or inguino-scrotal swelling (83%). All patients, therefore, underwent emergency surgery with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 11 normal appendices, four inflamed appendices and three perforated appendices in the inguinal hernial sac. Patients with a normal appendix (n = 11) had a mesh hernia repair without an appendicectomy. The rest of the patients (n = 7) with an abnormal appendix underwent emergency open appendicectomy followed by Bassini's sutured hernia repair. One patient died in the postoperative period of pneumonia. Only one recurrent hernia has been detected, with a median follow-up time of 6.4 years.

CONCLUSION

The inflammatory status of the appendix determines the type of hernia repair and the surgical approach. Incidental appendicectomy in the case of a normal appendix is not favoured.

Perforated appendix and periappendicular abscess within an inguinal hernia

We report an extremely rare case of complicated Amyand's hernia. A 61-year-old male patient was admitted with clinical signs of incarcerated right inguinal hernia and localised tenderness in the right iliac fossa. He underwent emergency surgery and the operative findings included perforated appendix and periappendicular abscess within a right inguinal hernia sac. Appendectomy and Shouldice's herniorrhaphy without prosthetic mesh placement were performed. Histology revealed the presence of a villous adenoma near the base of the appendix. We point out that although Amyand's hernia is a very rare clinical entity, it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia, especially when there are no pathological findings on the abdominal X-rays.

Ipsilateral Aymand's and Richter's hernia, complicated by necrosing fascitis

This study presents the case of a patient with necrobiosis or necrosing fascitis of the inguinal region, secondary to a complicated Amyand's hernia with a concomitant ipsilateral Richter's hernia. The patient was treated with open trans-abdominal surgery and hernia repair through the pre-peritoneal approach, plus anti-microbians, and thrice-daily wound cleansing and dressings to the inguinal region. Evolution was satisfactory. There are no reports in the literature of a case such as this.

Endoscopic totally extraperitoneal repair of incarcerated inguinal hernia

BACKGROUND

Incarcerated inguinal hernias have been considered a relative contraindication for endoscopic surgery, as its efficacy and safety is as yet unproven. With more experience and improved techniques, management of incarcerated hernias by the endoscopic approach has become possible with decreased patient discomfort and acceptable results.

AIM AND OBJECTIVE

To analyze the feasibility and effectiveness of Endoscopic Totally Extraperitoneal repair in incarcerated inguinal hernias.

METHODS

We retrospectively analyzed 34 patients-admitted under a single surgical unit with chronically incarcerated inguinal hernias-who underwent an elective endoscopic totally extraperitoneal repair. The 6-year period studied was from May 1997 to May 2003. Demographic characteristics, operative details (including modifications in technique and use of drains) and postoperative outcome including analgesic requirements, hospital stay, complications, and time taken to resume normal activity, were evaluated. A comparison was made with the results of 286 endoscopic primary, non-incarcerated, unilateral endoscopic totally extraperitoneal hernia repairs done during the same period.

RESULTS

With the help of modified techniques for reduction of the hernial sac, all the patients underwent a successful TEP repair. There were no conversions. The mean operating time was 84.4 min compared to 57 min in the non-incarcerated group. Three-fourths of the patients could be discharged within 24 h. Analgesic requirement was for an average of 5.5 days (vs 4.2 days in the non-incarcerated group). Time taken to resume normal activity was 7.5 days (vs 5.6 days in the non-incarcerated group). Two recurrences occurred. Follow-up period ranged from 13 months to 84 months.

CONCLUSIONS

With the help of modifications in operating technique, Endoscopic Totally Extraperitoneal repair is feasible and effective in patients with incarcerated inguinal hernias and encompasses the advantages of endoscopic procedures.