Appendix-preserving elective herniorrhaphy for de Garengeot hernia: two case reports

Abstract

Background Emergency appendectomy is often performed for de Garengeot hernia. However, in some cases, there may be a chance to perform an appendix-preserving elective surgery. Case description A 76-year-old woman presented to our hospital with complaints of a right inguinal swelling, which we diagnosed as a de Garengeot hernia using computed tomography (CT). B-mode ultrasonography (US) of the mass showed an appendix 4–6 mm in diameter with a clear wall structure; color Doppler US showed pulsatile blood flow signal in the appendiceal wall. Twenty-eight days later, herniorrhaphy with transabdominal preperitoneal repair (TAPP) was performed without appendectomy. Another 70-year-old woman presented to our hospital with complaints of a painful bulge in the right inguinal region. The diagnosis of de Garengeot hernia was made using CT. B-mode US showed an appendix 5 mm in diameter with a clear wall structure. Color Doppler US showed a pulsatile blood signal in the appendiceal wall. Seven days later, herniorrhaphy with TAPP was performed without appendectomy. Conclusion De Garengeot hernia is often associated with appendicitis; however, an appendix-preserving elective herniorrhaphy can be performed if US and intraoperative findings do not suggest appendicitis or circulatory compromise in the appendix.

Appendix-sparing laparoscopic transabdominal preperitoneal hernioplasty for a De Garengeot's hernia. A new case report and review of the literature

“…TAPP is commonplace today, becoming a routine procedure [ 21 , [23] , [24] , [25] ]. As Legnani et al [ 21 ] pointed out, this laparoscopic approach incorporates the advantages of a total abdominal overview and the observation “test time” of the repositioned appendix, which may improve management decisions.…”

“…Open surgery, with a simultaneous appendectomy and a primary hernia repair, is still considered the standard surgical treatment option, whatever the appendix condition. Since then, although unusual, a normal appendix in the femoral sac has been well documented in the literature many times [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ], but only a few cases of open surgery with preservation of the appendix have been published [ [14] , [15] , [16] , [17] , [18] ]. Since the emergence of laparoscopy for the treatment of incarcerated hernias [ 19 ], several papers have reported not only the successful minimally invasive management of this entity [ 20 ] but also the laparoscopic appendix-sparing of this condition, mainly after the coronavirus disease (COVID-19) pandemic [ [21] , [22] , [23] , [24] , [25] ].…”

De Garengeot’s hernia patients entirely treated laparoscopically: a safe and feasible alternative—a systematic review

“…When a De Garengeot hernia is clinically suspected, urgent surgical treatment should be performed as soon as possible. A totally laparoscopic approach should be considered the first-line alternative when enough expertise is available, in cases where no necrosis occurs of the appendix is found [ 29 ].…”

De Garengeot hernia in an elderly female: a case report

“…16 US as the advantage of being able to evaluate the vascularity of the appendix using the colour Doppler method. 17 Sepsis and peritonitis are relatively uncommon because of the anatomical structure of the femoral canal which means that perforation is confined to this area and not spilled over to the peritoneal cavity. 18 The treatment of De Garengeot hernia is an emergency, as it is for any femoral hernia incarcerated.…”

“…23 On what concerns about the appendix-preserving elective herniorrhaphy/hernioplasty, according to some studies, it seems to be an acceptable procedure if pre-operative imaging and intraoperative findings do not suggest acute appendicitis or circulatory compromise in the appendix. 9,17,24…”