D Papaconstantinou1, Z Garoufalia2, S Kykalos2, C Nastos3, D Tsapralis4, O Ioannidis5, A Michalinos6, G Chatzimavroudis7, D Schizas8. 1. Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece. Dimpapa7@hotmail.com. 2. Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece. 3. Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece. 4. Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece. 5. Fourth Department of Surgery, Aristotle University of Thessaloniki, General Hospital George Papanikolaou, Thessaloniki, Greece. 6. Department of Anatomy, European University of Cyprus, Nicosia, Cyprus. 7. Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece. 8. First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Abstract
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.
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.