A total laparoscopic treatment strategy for Amyand's hernia complicated with appendicitis: A case report.

• An appendix incarcerated in the inguinal hernia is defined as Amyand's hernia. • Preoperative diagnosis of Amyand's hernia is feasible with ultrasound and CT. • Laparoscopy for diagnostic and therapeutic purposes has been on an upward trajectory. • A potential total laparoscopy treatment strategy for Amyand's hernia was proposed, with fair outcomes. The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. It is even rarer with complicated appendicitis. Formerly it was treated via an open groin approach; recently there are new trends involving the use of laparoscopy for reduction and management of appendix. Conversely the role of laparoscopy in the following hernia repair was less discussed, with no standard care. We reported a case of Amyand's hernia complicated with appendix which was managed via a total laparoscopic strategy. A 49-year-old male presented with right groin mass with progressive pain for 3 days. Physical exams revealed incarcerated right inguinal hernia. Amyand's hernia with acute appendicitis was diagnosed preoperatively via computed tomography (CT). Emergent diagnostic laparoscopy was performed. Appendix was reduced, with appendectomy justified for signs of appendicitis. An interval total extraperitoneal (TEP) hernioplasty was performed 3 month later, with no adverse events postoperatively. In virtue of previous literature, we proposed a total laparoscopic strategy for Amyand's hernia which consists of transabdominal diagnostic laparoscopy, management of appendix, and either immediate or elective laparoscopic hernioplasty, based on status of appendix. This laparoscopic treatment strategy is feasible for Amyand's hernia, with minimized risk of surgical site infection (SSI), fair recovery and cosmesis. [ABSTRACT FROM AUTHOR]