A 76-year-old Japanese man with a right inguinal pain. Ultrasound and computed tomography confirmed his vermiform appendix herniated into the right inguinal canal. We managed a simultaneous laparoscopic total extraperitoneal inguinal hernia repair with mesh and laparoscopic appendectomy...
Posted June 6,2019 in General Medicine.
A vermiform appendix located within an inguinal hernia sac is termed Amyands hernia (AH); Claudius Amyand reported a case of a perforated appendix in an inguinal hernia sac in 1735 . The incidence of an appendix within an inguinal hernia is seen in 0.1% of all inguinal hernias, and the diagnosis is usually made intraoperatively . Therefore, most of these cases are managed during surgery. We present a case of a preoperatively diagnosed Amyands hernia (AH) in a man who underwent treatment by simultaneous laparoscopic totally extraperitoneal (TEP) repair and laparoscopic appendectomy.
Classification systems for Amyands hernia 
Reduction or appendectomy(depending on age), mesh hemioplasty
Acute appendicitis localized in the sac
Appendectomy through hernia, endogenous repair
Acute appendicitis, peritonitis
Appendectomy through laparotomy, endogenous repair
Acute appendicitis, other abdominal pathology
Appendectomy, diagnostic workup and other procedures as appropriate
We performed preperitoneal mesh placement and total laparoscopic appendectomy after reducing the appendix by an intraperitoneal approach to treat a preoperatively diagnosed AH. This process was introduced to allow inspection of the hernia canal and confirm the absence of a perforated appendix or peritonitis, as well as observe the degree of fibrous connections between the vermiform appendix and the surrounding hernia sac, which helped to avoid tearing the appendix. The main reasons for selecting TEP repair are that the procedure is not influenced by intra-abdominal conditions and avoids entering the peritoneal cavity, thus protecting the mesh from bacterial contamination.
In conclusion, a laparoscopic mesh inguinal hernia repair combined with laparoscopic appendectomy can be performed for the surgical treatment of AH type 1 and select cases of AH type 2. It may be regarded as a safe technique with minimal morbidity to the patient. In particular, TEP repair of an inguinal hernia with mesh after laparoscopic hernia reduction may help to avoid mesh contamination in patients with an AH.