Finding and fixing Amyand's hernia during repeat groin hernia surgery

Abstract

Incidental Amyand's hernia is a rare intraoperative finding during inguinal hernia repair and may pose a management dilemma, particularly in recurrent cases where prior anterior repair limits surgical options. In these settings, careful consideration is required for optimal plane selection and the safety of mesh placement after appendectomy. A 67-year-old man with a history of prior anterior Lichtenstein repair presented with a recurrent right inguinal hernia. A posterior laparo-endoscopic repair using the enhanced-view totally extraperitoneal (eTEP) technique was performed in accordance with international guidelines. During hernia sac dissection, a controlled peritoneal opening was intentionally created to safely identify the sac contents. The cecum and a macroscopically normal appendix were found within the sac, consistent with a Type I Amyand's hernia. Laparoscopic appendectomy was performed, and the repair was completed in the preperitoneal space using the eTEP approach, without conversion to a transabdominal preperitoneal (TAPP) technique. The postoperative course was uneventful, with no recurrence or chronic pain at six-month follow-up. This case demonstrates the utility of the eTEP approach as a posterior strategy for recurrent inguinal hernia repair when unexpected intraoperative findings occur. In selected patients with non-inflamed Amyand's hernia, appendectomy combined with prosthetic mesh repair can be performed safely without compromising outcomes.