Amyand's Hernia: A Systematic Review of Clinical Presentations, Surgical Management, and Outcomes in an Uncommon Picture of a Common Entity.

Abstract

Amyand's hernia, defined as the presence of the appendix within an inguinal hernia sac, is rare but poses diagnostic and operative challenges. Its management remains controversial, particularly regarding appendectomy and mesh use in contaminated settings. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of English-language case reports and series published between 2000 and March 2025. Databases were searched using standardized terms; inclusion required cases with operative and outcome details. After excluding review studies and studies for which full articles were not available, we identified seven studies encompassing 17 cases of Amyand's hernia over a 20-year period. Data extracted encompassed demographics, clinical presentation, intraoperative findings per Losanoff-Basson classification, operative technique, mesh usage, postoperative outcomes, follow-up, and recurrence. Classification and contamination-guided strategies remain central. Mesh repair appears safe in clean or minimally contaminated settings, whereas gross contamination favors tissue repair or staged reconstruction.