Laparoscopic management of a newborn with a right Amyand′s hernia and a left incarcerated inguinal hernia

Abstract

A one month old boy presented with left incarcerated inguinal hernia. After unsuccessful manual reduction, we decided to perform laparoscopic herniorrhaphy. Laparoscopic examination showed a left hernia with intestinal loops that entered into the internal inguinal ring, on the right side there was an unknown patency of the peritoneal vaginal duct with the appendix completely incarcerated within the sac. On the left side, the loops were reduced with a combined technique of external manual pressure and internal pulling by forceps; the bowel was inspected, and the hernia was repaired. On the right side, the appendix was strongly adherent with the peritoneal vaginal duct, and the reduction was not possible. The appendix was dissected from the sac using a 3-mm monopolar hook and than reduced into the abdomen, then right herniorrhaphy was performed. Two days after surgery, the baby had fever and abdominal distension. He was re-operated through mini-Pfannenstiel incision and an ischemic appendix was identified and removed. Postoperative period was uneventful. In our case, laparoscopy allowed for simultaneous reduction under direct visual control, inspection of the incarcerated organ, definitive repair and incidentally discovery and treatment of the contralateral incarcerated Amyand's hernia. In case of incarcerated appendix, appendectomy is preferable during the same procedure to reduce the incidence of postoperative complications.

Laparoscopic Versus Open Inguinal Hernia Repair in Pediatric Patients: A Systematic Review

“…44,45 From a technical point of view, the laparoscopic approach is easier but technically more demanding for the surgeon because he or she has to be able to work in a very small space because of the bowel distension. Therefore, it is often useful to perform one or two enemas the day before operation and to use simethicone to empty the intestinal loops of gas and stools, both of which allow the creation of a larger working space in the abdominal cavity.…”

“…4,20,26,27,30,34,45,46 As for the incidence of type of rare hernia, the most common of all was a direct hernia (81.5%, 57 patients), followed in order of frequency by femoral hernia (10%, 7 patients), hernia ''en pantalon'' (4.3%, 3 patients), and a combination of indirect hernia with femoral hernia (1.4%, 1 patient), indirect hernia with direct and femoral hernia (1.4%, 1 patient), and Amyand's/Littrè's hernia (1.4%, 1 patient). No rare hernias were identified in the OH patients (Table 3).…”

A case of Amyand's hernia in a preterm infant

“…Some authors advocate for laparoscopic exploration of an inguinal hernia in infants. 5,13 Instances where this approach is useful is when the hernia has previously been incarcerated, or when manual reduction has been difficult. 13 The advantage of laparoscopic surgery is the ability to inspect the contralateral side as well the incarcerated organ.…”

“…13 The advantage of laparoscopic surgery is the ability to inspect the contralateral side as well the incarcerated organ. 5,13 Incidental appendicectomy in the case of a normal appendix is controversial as the appendix has been used for various reconstructive procedures. 4,11 Due to its anatomical and structural features, the appendix has been used as a conduit for biliary, urethral, vaginal, oesophageal and voice reconstructive procedures.…”

“…1,3 De Garengeot hernia is used to describe an appendix found in a femoral hernia. 3,5 Preoperative diagnosis is not common, and the presentation is usually of an incarcerated inguinal hernia.…”