, Volume 12, Issue 3, pp 325-326
Date: 24 Jan 2008

Amyand hernia: a classification to improve management

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We read with great interest the recent report by Milanchi and Allins [1] on history, imaging, and management of Amyand’s hernia. The authors recommend reduction of the appendix and mesh hernioplasty if there is no acute appendicitis, and appendectomy followed by endogenous repair if an inflamed vermiform appendix is found [1]. Although the recommendations of Milanchi and Allins are certainly acceptable, they do not fully reflect the potential variability of clinical scenarios resulting from the four basic types of Amyand’s hernias (Table 1). While the authors’ recommendations apply to Amyand Types I and II, the management of Types III and IV are more complex, and should also be considered.

The absence of inflammatory changes in Type 1 approximates elective hernioplasty. Using a permanent prosthesis in such cases carries the expectation of an improved longevity of the repair because it avoids tension on the suture lines and circumvents the metabolic problems related to collagen deficien ...