ISPUB.COM The Internet Journal of Surgery Volume 26 Number 2 1 of 5 Vermiform Appendix Inside A Hernia: Our Experience P Patrikakos, G Velimezis, G Kapogiannatos, J Georgiou, E Perrakis, V Patrikakos, A Perrakis Citation P Patrikakos, G Velimezis, G Kapogiannatos, J Georgiou, E Perrakis, V Patrikakos, A Perrakis. Vermiform Appendix Inside A Hernia: Our Experience. The Internet Journal of Surgery. 2010 Volume 26 Number 2. Abstract Aim: The presence of the vermiform appendix inside a hernia sac is usually called Amyand's or De Garengot Hernia. The purpose of this study is to report our experience with 12 cases within the last 15 years.Methods: We searched patient files of our department since 1992 and found 12 cases of patients with the appendix found inside a hernia. Patient characteristics, treatment and postoperative outcome were analyzed.Results: There were ten men and two women with a median age of 74 years (range 55-90). Seven patients (six males, one female) presented to the emergency department with a tender inguinal mass and were operated under the diagnosis “strangulated hernia”, with an inflamed appendix inside the hernia found intraoperatively in six of them while in one male patient a strangulated sliding hernia containing the cecum with the appendix was found. Appendectomy was performed in all patients but the one with the strangulated sliding hernia. Hernias were repaired with the use of synthetic patch or suture technique depending on individual patient characteristics. The other four male patients were routinely operated for right inguinal hernia and the appendix was found intraoperatively. Appendectomy was performed in all patients and the hernia was repaired with the use of a polypropylene mesh. The other female patient was operated for an incisional hernia (right lower quadrant) and appendectomy was performed with suture repair of the hernia.Conclusion: The inflammatory status of the appendix combined with the patient's individual characteristics determines the hernia repair. Appendicectomy should be performed as long as it does not complicate the recovery of the patient. INTRODUCTION It is a generally rare condition to find the appendix within an inguinal hernia. De Garengot in 1731 was the first to describe successful drainage of an acutely inflamed appendiceal groin abscess [1], while in 1735 Amyand reported the first appendiceal resection for appendicitis in the sac of an inguinal hernia [2]. The appendix can be found inside an inguinal hernia during a routine hernia repair and the incidence varies amongst references from 0.5 to 1% [3-5]. The finding of acute appendicitis in inguinal hernias is reported to be as low as 0.08% [3]. However, there have been case reports of left inguinal hernias containing the appendix [6], while the appendix has been found in port-site hernias after laparoscopic surgery [7]. The treatment in such a rare situation remains controversial. There are questions to be answered such as: is it safe to perform an appendectomy when finding the appendix during a routine hernia repair and thus risk an increase in morbidity by combining an aseptic operation (hernia repair) with a contaminated one (appendectomy)? Is it safe to use a synthetic mesh or patch in the above situation and what if appendicitis is present? There have been reports of appendicitis shortly after laparoscopic hernia repairs, where the surgeon cannot visualize the sac contents. It remains a mystery in a case of a hernia containing the appendix whether the remaining of the appendix can cause future problems [8]. The diagnosis of a hernia containing the appendix is usually made intraoperatively. Many surgeons suggest that appendectomy should be performed and the hernia should be repaired without the use of a synthetic mesh [9,10], while others propose laparoscopic appendectomy and open hernia repair without the use of a prosthetic mesh [11]. Considering the fact that such a situation is rare and the diagnosis is almost always made intraoperatively, surgeons should be able to deal with the situation and decide how to best manage the patient. MATERIAL AND METHODS From January 1992 since August 2008, 4.308 hernias have been operated in our department and 782 appendectomies have been performed. Out of those, 1748 were right inguinal