A two-stage minimally invasive surgical treatment for Amyand’s hernia with acute appendicitis

Background. Rare forms of acute appendicitis are known to be difficult to diagnose and treat, include the infringement of the appendix in case of Amyand hernia (in the hernial gate of the inguinal hernia). The literature has not proposed an up-to-date treatment algorithm for this disease. Objective. The goal of this study was to develop the features and opportunities of the algorithm for Amyand hernia with acute appendicitis. Material and methods. This paper presents the features of the course, diagnosis, and surgical treatment of an Amyand hernia with acute appendicitis. The paper also presents an analysis of a clinical case of acute appendicitis with an Amyand hernia and one of the options for a tactical solution to this situation in accordance with the standards of modern surgery. Results. In our clinical case, we divided the surgical treatment into two stages. At the first stage, we resorted to laparoscopic appendectomy, but refrained from simultaneous alloplasty in favor of simple suturing of the hernial gate (local autoplasty) from laparoscopic access, followed by delayed full-fledged alloplasty with a mesh prosthesis at the second stage of surgical treatment. This choice was associated with the presence of destructive perforating changes in the appendix and a high level of local contamination during the primary surgery. Conclusion. The postoperative period proceeded smoothly after both the first and second stages of surgical treatment. We have not encountered any complications and can recommend this treatment algorithm.