© 2009 Surgeon 7; 4: 198-202 198 | the royal colleges of surgeons of edinburgh and ireland AMYAND’S HERNIA: 10 YEARS’ EXPERIENCE 1 Division of Visceral and Transplantation Surgery 2 Division of Cardiovascular Surgery University Hospital of Geneva, Geneva, Switzerland Correspondence to: Ihsan Inan, Division of Visceral Surgery, Department of Surgery, University Hospital of Geneva, 24, Micheli- Du-Crest, 1211 Geneva 14 Switzerland Tel: +41227892101 Fax: +41227892102 Email: ihsan.inan@hcuge.ch I. Inan 1 P. O. Myers 1,2 M. E. Hagen 1 M. Gonzalez 1 P. Morel 1 Background: Amyand’s hernia is an atypical groin hernia which contains the vermiform appendix. The aim of this study was to review a single institution’s experience in the clinical presentation, management and prognostic factors of this rare hernia. Methods: The authors reviewed records of all patients undergoing hernia surgery from 1996 to 2006 at their institution, a tertiary care, University-afliated hospital. Results: Twelve patients (six men) with a median age of 88 years (range 60-97) were included. Six presented with right inguinal hernias and six presented with right femoral hernias. All required emergency surgery: eight for strangulated hernias, two for hernias with lower quadrant peritonism and two for incarcerated hernia. Despite small differences in outcome and length of hospitalisation between Amyand types, appendix inammation, pre-operative blood examinations and hernia localisation, only right lower quadrant peritonism as a presenting sign (p=0.004) and age greater than 90 years old (p=0.04) were signicantly associated with a poor outcome. Conclusion: Amyand’s hernia is a rare hernia which is seldom diagnosed before operation. It must be considered in the evaluation of a strangulated or incarcerated hernia. Further studies are required to dene the optimal surgical strategy, prognostic factors and risks of hernia recurrence. keywords: appendix, acute appendicitis, hernia, adult, Amyand Surgeon, 1 August 2009, pp. 198-202 original article Introduction Amyand’s hernia is an atypical hernia, diagnosed by finding the vermiform appendix in a groin hernia, usually presenting as a strangulated or incarcerated hernia. It is a rare disease, named after Claudius Amyand, founder of London’s St George’s Hospital and first to perform an appendectomy in 1735, for an acute appendicitis inside an inguinal hernia. 1 Fernando et al. categorised Amyand’s hernia accord- ing to the degree of appendix inflammation within a groin hernia: (a) non-inflamed, (b) inflamed or (c) perforated appendix. 2 Furthermore, some authors propose that an Amyand’s hernia located at the femoral canal should be specifically called De Garengeot hernia, after the Parisian surgeon René Jacques Croissant de Garengeot, who first described this hernia in 1743. 3,4 Although Amyand’s hernia is known to most well-read surgeons, data on this rare hernia are scarce and mostly limited to case reports, with the exception of a recent review and three retrospec- tive analyses. 5-9 Knowledge of this rare disease is essential to allow pre-operative diagnosis, as well as rapid and adequate management. Te aim of this study was to review a single institution’s experience over ten years, including clinical presentation and management of Amyand’s hernia, and attempt to reach conclusions on prognostic factors and risks of recurrence. Methods Patient search strategy and enrolment Te authors retrospectively reviewed records of patients undergoing surgery for hernia from 1996 to 2006 at their institution, selecting those in which an Amyand’s hernia was described. It was defined as presence of the vermiform appendix within a groin hernia sac and was classified into three types, as described previously. 2 Te following parameters were collected and analysed: age, sex, chief complaint, history and clin- ical manifestations, white blood count (WBC) and C-reactive protein (CRP) level at admission, diag- nostic imaging, type of surgery and outcome. Femo- ral and inguinal hernias were compared. Duration of symptoms, WBC and CRP were compared with the type of Amyand’s hernia found at operation. WBC higher than 11x10 9 /L and CRP higher than 10mg/L were categorised as elevated. Te primary endpoint was 30-day hospital mortality. Secondary endpoints were post-operative surgical wound infection, hospital length of stay and hernia recurrence after discharge. Statistical analysis Te collected data were analysed using SPSS statistical software (SPSS 13 for Mac, SPSS Inc., Chicago, IL). Kolmogorov-Smirnov and Shapiro- Wilk normality tests each showed a non-normal distribution of the collected continuous data; non-