Normal Appendix in the Elective Inguinal Hernia Repair: Case Report and Review of Literature

INTRODUCTION: The presence of the vermiform appendix in an inguinal hernial sac is known as an Amyand’s hernia. In the elective hernia repair, this represents a rare finding and the decision to perform appendectomy is always ambiguous. The literature seems to claim the idea that a normal appendix should be preserved unless the benefits of an appendectomy outweigh the risks of a future acute appendicitis. Our purpose was to analyse all published clinical cases of Amyand’s hernia indexed in MEDLINE and evaluate patient’s characteristics and the surgeons’ decisions regarding prophylactic appendectomy in these cases.METHODS: A bibliographic search of MEDLINE database using “Amyand’s Hernia” as keywords was done. Inclusion criteria included clinical cases in adults, where a normal, non-inflamed appendix was encountered during elective hernia repair. We also present the clinical case from our institution. RESULTS: We identified 25 papers from which 41 clinical cases were extracted. In more than half the clinical cases the surgeons opted for a prophylactic appendectomy. This decision seemed to have no impact on the type of hernia repair (with/without mesh) or on the reported complications. CONCLUSION: Amyand’s hernia is a rare finding, and even though prophylactic appendectomy is not recommended, most of the surgeons in the published clinical cases opted to do so. The absence of evidence-based information and the very low risk associated with appendectomy in this context may explain this option. The final decision therefore remains surgeon-dependent.