Amyand's hernia: Our experience in the laparoscopic era

Transabdominal Preperitoneal Versus Lichtenstein Procedure for Inguinal Hernia Repair in Adults: A Comparative Evaluation of the Early Postoperative Pain and Outcomes

Inguinal hernia repairs are one of the most common procedures in general surgery. In addition to classical open surgery, laparoscopic techniques, such as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) hernia repair, have gained acceptance and are increasingly used for inguinal hernia repairs, and these three techniques are the only standards for inguinal hernia repairs. This study aimed to compare the results of inguinal hernia repairs in adult patients using the TAPP patch technique and Lichtenstein techniques regarding the level of pain perceived one day after surgery and the number of days of hospitalization. A two-year study was performed on 129 patients who underwent TAPP vs. 109 patients who underwent Liechtenstein hernia repair. Our results revealed statistical significance for both variables (Tpain(233) = -7.12, p< 0.001, d=2.92; Tdays of hospitalization(233) = -31.34, p< 0.001, d=4.01). TAPP is a safe method for inguinal hernia repairs, allowing quick recovery and less postoperative pain than the classical Liechtenstein technique.

A case report of incarcerated inguinal hernia: Amyand's hernia with adenocarcinoma tumor

INTRODUCTION

Inguinal hernia is one of the most common surgical problems, often posing technical challenges even to expert surgeons. Amyand's hernia (AH) is an inguinal hernia whose sac contains the vermiform appendix. Primary appendiceal neoplasms are rare. We report the case of an appendiceal adenocarcinoma within an Amyand's hernia, presenting as an incarcerated right inguinal hernia.

PRESENTATION OF CASE

A 87-year-old male presented in the emergency department due to a persistent right inguinal pain. Clinical examination revealed a tender right groin mass. Under the diagnosis of an right inguinal hernia, an operation was taken. Intraoperatively, an inflamed appendix and a part of the cecum were found in the hernia sac. The operation was completed with an ileocecal resection and a modified Bassini hernia repair. Histological examination revealed a adenocarcinoma of the appendix.

DISCUSSION

Amyand's hernia is an inguinal hernia that contains vermiform appendix in its sac. It consists 1% of all inguinal hernias while appendicitis in an Amyand's hernia accounts for 0.1% of all appendicitis cases. Adenocarcinomas of the appendix are even rarer, accounting for 0.2% to 0.5% of all intestinal malignancies, and 4%-6% of primary appendiceal neoplasms. Diagnosis is usually established intraoperatively.

CONCLUSION

A malignancy of the appendix should always be in the differential diagnosis of a right inguinal mass, in order to provide optimum surgical treatment.

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

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Amyand’s hernia management remains controversial.

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Use of mesh or not in Amyand’s hernia.

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Role of CT scan in diagnosis of Amyand’s hernia.

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Literature review of Amyand’s hernia and classification systems.

Introduction

An Amyand’s hernia is a rare disease where a vermiform appendix is found within an inguinal hernia sac. It is reported in the literature as having an incidence between 0.4%–1.0% of reported hernia cases. Typically, an incidental finding, Amyand’s hernia is consequently found more frequently intra-operatively rather than preoperatively.

Presentation of case

This case is a recount of a 56-year-old male, who presented in an outpatient setting for the evaluation of right inguinal pain and bulge. The patient was diagnosed with a vermiform appendix within the indirect hernia. The patient underwent elective repair of his inguinal hernia via Transabdominal Preperitoneal (TAPP) approach of the hernia with avoidance of appendectomy.

Discussion

An Amyand’s hernia presents a challenging diagnosis and the treatment algorithm is contingent on the condition of the appendix in individual cases. This case presents a Type 1 Amyand’s hernia that was repaired through laparoscopic approach using prosthetic mesh. The aim of this case study highlights the approach to surgical decision making in the diagnosis and treatment of Amyand’s hernia proposed in the current literature.

Conclusion

This case presents a rare condition known as Amyand’s hernia followed by a discussion on the epidemiology, diagnostic workup, and treatment options. Treatment is dependent on the state of the appendix found in the hernia sac and the clinical scenario. Comprehensive literature review shows that the true prevalence of this disease is lower than classically described and still has no clear standardized approaches.

Implications of the presence of the vermiform appendix inside an inguinal hernia (Amyand's hernia): a systematic review of the literature

PURPOSE

To identify and sum all available evidence pertaining to the management of Amyand's hernia (AH).

METHODS

A systematic search of the MedLine, Scopus, and Google Scholar databases was performed for studies published until January 2020.

RESULTS

In total, 111 studies incorporating 161 patients were identified, 96 (86.4%) being case reports, 11 (9.9%) case series, and 4 (3.7%) retrospective patient cohorts. Mean patient age was 58.5 ± 19.6 years with 136 (83.9%) being males and 25 (16.1%) females. Furthermore, 149 (92.5%) cases were right-sided hernias while 12 (7.5%) cases were left-sided. Overall, 62.3% of patients presented emergently and 77.3% of patients' cohort were eventually diagnosed with incarcerated AH. Preoperative diagnosis of AH was established in 23.1% of patients and was achieved either by ultrasound (25%) or CT scan (75%). Operative findings consisted of normal appendix in 73 (45.4%) cases, uncomplicated appendicitis in 62 (38.5%) patients, and perforated appendix in 26 (16.1%). Regarding patients with appendicitis, mesh placement was reported for 17 (21.2%), herniorrhaphy was performed for 51 (63.7%) while 12 (15.1%) patients did not undergo hernia repair during the initial operation. Mesh utilization rates were significantly higher in patients with a normal appendix. Seven cases involved AH containing appendiceal neoplasms. Thirteen cases (8.6%) of postoperative complications were documented and a single case of postoperative death.

CONCLUSION

AH is a rare type of inguinal hernia usually complicated by appendicitis. Hernia reconstruction should be tailored to each patient individually according to the extent of inguinal canal inflammation.

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

The presence of vermiform appendix in an inguinal hernia sac is known as Amyand’s hernia. Amyand’s hernia complicated with acute appendicitis is an extremely rare entity with challenging diagnosis and large debate about the optimal treatment option. We report a case of a 58-year-old man presenting to the Emergency Department with an incarcerated right inguinal hernia. At laparoscopy, an inflamed appendix was identified within the inguinal canal, representing an indirect Amyand’s hernia. A laparoscopic appendicectomy was performed followed by a trans-abdominal pre-peritoneal mesh repair of the aforementioned hernia. We report this rare clinical entity raising physicians’ awareness to include acute appendicitis within an Amyand’s hernia in the differential diagnosis of incarcerated inguinal hernias, along with a successful minimally invasive surgical approach.

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.