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Combined totally extraperitoneal preperitoneal repair and laparoscopic appendectomy for treatment of an asymptomatic, incarcerated Amyand’s hernia in an adult

Amyand’s hernia is a rare variety of inguinal hernia wherein the vermiform appendix is contained within the hernia sac. It is generally reported to present emergently with symptoms of an incarcerated inguinal hernia and is diagnosed intraoperatively. We report the first known case of an incarcerated Amyand’s hernia presenting asymptomatically in an adult, with subsequent diagnosis during elective laparoscopic repair of the hernia. This case highlights the potential for this variety of hernia to present to surgeons who perform only elective hernia repairs. We describe our method of a combined preperitoneal TEP repair of the hernia with conversion to intraabdominal laparoscopy to reduce the appendix and perform appendectomy. This technique has several benefits, including minimal comorbidity to the patient and minimal risk of infection. The necessity for appendectomy in cases of Amyand’s hernia without appendiceal inflammation is debated, as is the use of prosthetic mesh to repair the hernia when appendectomy is performed. The threshold to remove the appendix can be low if infection risk is minimized.