Second Department of Surgery, Athens Naval and Veterans Hospital, Eptanisou 18, Agia Varvara, Athens, Greece.
First Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece.
World J Surg. 2021 Jun;45(6):1763-1770. doi: 10.1007/s00268-021-05983-y. Epub 2021 Feb 17.
Protrusion of the appendix within an inguinal hernia is termed an Amyand's hernia. A systematic review of case reports and case series of Amyand's hernia was performed, with emphasis on surgical decision-making.
The English literature (2000-2019) was reviewed, using PubMed and Embase, combining the terms "hernia", "inguinal", "appendix", "appendicitis" and "Amyand". Overall, 231 studies were included, describing 442 patients.
Mean age of patients was 34 ± 32 years (adults 57.5%, children 42.5%). 91% were males, while a left-sided Amyand's hernia was observed in 9.5%. Of 156 elective hernia repairs, 38.5% underwent appendectomy and 61.5% simple reduction of the appendix. 88% of the adult patients had a mesh repair, without complications. Of 281 acute cases, hernial complications (76%) and acute appendicitis (12%) were the most common preoperative surgical indications. Appendectomy was performed in 79%, more extensive operations in 8% and simple reduction in 13% of cases. A mesh was used in 19% of adult patients following any type of resection and in 81% following reduction of the appendix. Among acute cases, mortality was 1.8% and morbidity 9.2%. Surgical site infections were observed in 3.6%, all of which in patients without mesh implantation.
In elective Amyand's hernia cases, appendectomy may be considered in certain patients, provided faecal spillage is avoided, to prevent mesh infection. In cases of appendicitis, prosthetic mesh may be used, if the surgical field is relatively clean, whereas endogenous tissue repairs are preferred in cases of heavy contamination.
阑尾疝出至腹股沟疝内被称为艾米安德（Amyand）疝。对艾米安德（Amyand）疝的病例报告和病例系列进行了系统评价，重点在于手术决策。
检索 2000 年至 2019 年的英文文献，使用 PubMed 和 Embase 数据库，检索词包括“疝”“腹股沟”“阑尾”“阑尾炎”和“艾米安德（Amyand）”。共纳入 231 项研究，共计 442 例患者。
患者的平均年龄为 34 ± 32 岁（成人占 57.5%，儿童占 42.5%）。91%为男性，左侧艾米安德（Amyand）疝占 9.5%。在 156 例择期疝修补术中，38.5%行阑尾切除术，61.5%行单纯阑尾复位。88%的成年患者采用了网片修补，无并发症。281 例急性病例中，最常见的术前手术指征是疝并发症（76%）和急性阑尾炎（12%）。79%的患者行阑尾切除术，8%的患者行更广泛的手术，13%的患者行单纯复位。在任何类型的切除术后，19%的成年患者使用网片，81%的患者在阑尾复位后使用网片。在急性病例中，死亡率为 1.8%，发病率为 9.2%。有 3.6%的患者发生手术部位感染，所有这些患者均未植入网片。
在择期艾米安德（Amyand）疝病例中，如果避免粪便溢出，可以考虑在某些患者中进行阑尾切除术，以预防网片感染。对于阑尾炎患者，如果手术部位相对清洁，可以使用假体网片，如果污染严重，则首选内源性组织修复。
