The routine use of mesh and the role of appendectomy for the Amyand’s hernia cases

Objective: Amyand’s hernia is described as the presence of vemiform appendix in the inguinal hernia sac and this condition is mostly incidental. The aim of this retrospective analysis was to evaluate the role of appendectomy and the mesh repair in the patients with Amyand’s hernia.
Material and Methods: The clinical and laboratory findings, and treatment modalities of 12 patients with Amyand’s hernia among 6630 inguinal hernia patients who underwent surgery between January 2000 and May 2015, were retrospectively recorded. Moloney darn repair was performed in the patients who had inflamed appendix whereas Lichtenstein repair was performed in the patients who had non-inflamed appendix.
Results: All of the patients were male with a mean age of 48.9 years (range 28-67 years). The most common symptoms and pain in the patients were swelling of the right inguinal area and pain. Three patients underwent emergency surgery due to incarcerated right inguinal hernia while remaining nine patients underwent elective surgical repair. The diagnosis of Amyand’s hernia was made during hernia surgery and routine appendectomy was performed in all patients. The only complication was the wound infection which was observed in the patient with perforated appendicitis (8.3%). The mean follow-up period was 80.4 months (range: 8-180 months) and there were no recurrent cases.
Conclusion: The appendectomy can be performed safely in the patients with Amnyand’s hernia. The repair for inguinal hernia may provide satisfactory results in the absence of inflammation.

Amyand herni vakalarýnda apendektomi ve rutin yama kullanýmýnýn yeri

Amaç: Amyand fýtýðý, inguinal fýtýk kesesi içerisinde apendiksin bulunma hali olup genellikle rastlantýsal olarak saptanýr. Amacýmýz olgulara uygulanan tedavileri deðerlendirerek nadir görülen bu herniye yönelik tedavi yaklaþýmýný ve özellikle appendektomi ve herni onarýmý için greft kullanýmý sonuçlarýný deðerlendirmektir.
Gereç ve Yöntemler: Kliniðimizde Ocak 2000-Mayýs 2015 tarihleri arasýnda ameliyat edilen 6630 inguinal fýtýktan, Amyand fýtýðý saptanan 12 hastanýn klinik bulgularý, laboratuvar sonuçlarý ve tedavi yöntemleri retrospektif olarak incelendi. Apendiks inflamasyonu olan hastalara Moloney Darn herni onarýmý (að örme) yapýlýrken, apendiks inflamasyon bulgusu olmayan hastalara ise Lichtenstein herni onarýmý yapýldý.
Bulgular: Hastalarýn tümü erkek olup yaþ ortalamasý 48.9±13 yýl (28-67 yýl) idi. Hastalarýn en sýk baþvuru þikayeti sað kasýkta þiþlik ve aðrý idi. Üç hastada acil, 9 hastada ise elektif ameliyat sýrasýnda taný kondu. Bütün hastalara apendektomi yapýldý. Üç hastada fýtýk anatomik yöntemle tamir edilirken, 9 hastaya prolen greft onarýmý yapýldý. Perfore apandisiti olan bir hastada yara yeri enfeksiyonu (%8.3) geliþirken diðer hastalar sorunsuz, taburcu edildi. Ortalama 80.4±60 aylýk (8-180 ay) takip sonucunda hiçbir hastada nüks saptanmadý.
Sonuç: Amyand fýtýðýnda nüksü önlemek için ciddi enflamasyon bulgularý yoksa apendektomi eþliðinde greft ile fýtýk tamiri güvenli bir þekilde uygulanabilir.