Controversies Regarding Mesh Utilisation and the Attitude towards the Appendix in Amyand’s Hernia—A Systematic Review

Abstract

Inguinal hernia containing the vermiform appendix is a rare entity. It is more common in children than in adults. It can be discovered incidentally during the surgical intervention performed for the cure of the inguinal hernia or when the appendix shows inflammatory changes, a situation that can lead to diagnostic confusion with a number of other diseases. Imaging can guide the diagnosis, which often comes as an intraoperative surprise. The therapeutic approach is controversial both in terms of whether or not to perform an appendectomy in the case of an appendix without inflammatory changes and especially in terms of using a mesh during the hernia repair process. Since the pathology is not very frequent, there are no standardized stages in terms of surgical ethics that can guarantee good surgical practice. The study aimed to carry out a review of the specialized literature to obtain some conclusions or trends regarding the management of this pathology. The low frequency of this type of hernia did not allow the consultation of large-scale studies or extensive reviews focusing on case reports or case series communications. The obtained results were statistically analyzed and integrated in relation to the surgical attitude depending on the particularities of the condition.

Amyand’s hernia repair in an asymptomatic patient—a case report and a review of the literature

“…In cases with findings of appendicitis, the treatment of choice was appendectomy, while in cases in which the appendix was presented without inflammatory changes, there was no consensus between the reduction of appendix in the peritoneal cavity and the appendectomy. Also, it was interesting that a mesh repair was performed in all patients, aside from the presence or not of an inflamed appendix [ 9 ].…”

Amyand's hernia with concurrent appendicitis: A case of interval laparoscopic herniorrhaphy and literature review

“…A systematic review recommends against the placement of mesh if there is a local inflammation process even after resection of the sac. There is an increased risk of wound infection, mesh infection, rejection of allograft, and subsequent hernia recurrence [ 13 ]. Hence, laparoscopic mesh herniorrhaphy was delayed and staged until local inflammation resolved following appendectomy.…”