To mesh or not to mesh? Comparing safety, efficacy and outcomes of mesh and suture repair for Amyand's hernia: a systematic review.

Abstract

<h4>Introduction</h4>Amyand's hernia (AH) is a relatively rare type of inguinal hernia, characterized by the presence of the appendix inside the hernia sac. The aim of this study is to examine the role of prosthetic mesh in AH repair compared to the traditional suture repair techniques regarding safety, efficacy and various postoperative complications.<h4>Evidence acquisition</h4>A systematic review of MEDLINE via PubMed, Scopus and Google Scholar was performed, aligned with the PRISMA guidelines. All studies in English language reporting AH repair using mesh or suture techniques in adults including more than 5 patients were included.<h4>Evidence synthesis</h4>Twelve studies reported a total of 123 patients with AH, 58 of which were repaired using prosthetic mesh and 71 with traditional suture techniques. The overall presence of an inflamed appendix was 58.5%. Appendicitis was present in 12.7% of the mesh repair group compared to a 95.5% of the suture repair group. Surgical site infections (SSIs) were 3.4% of all complications in the mesh group compared to 6.8% in the suture repair group. Extended hospital stay of more than 10 days was observed in 12.7 in the mesh group compared to 7.3% of the suture repair group.<h4>Conclusions</h4>The most technically challenging cases with septic conditions are appropriate for suture repair only, while mesh repair is usually performed in AH cases without appendix inflammation and is more commonly used in conjunction with appendix reduction into the abdominal cavity rather than appendicectomy.