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Presence of an appendix in a hernial sac (Amyand's hernia) is a rare entity, still rarer is an inflamed appendix within the hernial sac. An endoscopic total extraperitoneal repair of a right-sided incarcerated inguinal hernia is described. The inguinal hernial sac contained an inflamed appendix. An associated small incisional hernia at the lower end of a midline suprapubic scar for a Millin's prostatectomy was simultaneously repaired.

The endoscopic approach to inguinal hernia repair is an excellent tool to detect and treat occult contralateral hernias. The incidence of hernia occurring at the contralateral side after a previous bilateral exploration is low, hence a prophylactic repair on the contralateral side is not recommended on a routine basis.

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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.