Right Direct Inguinal Hernia in Patients Underwent Open Surgery for Appendicitis – A Retrospective Study

ABSTRACT

Introduction: Acute appendicitis is the most common surgical emergency faced in today’s world. The inguinal hernia is the most common type of hernia seen in surgical practice. It can be of a direct and an indirect type. While the indirect type has a congenital cause, direct hernias are attributable to the weakness of abdominal wall musculature. Aim: This study aims to study the prevalence of right (direct) inguinal hernia in patients who underwent open surgery for appendicitis. Materials and Methods: In this retrospective study, 100 patients who underwent surgery for the right direct inguinal hernia were included in the study. Patients’ demographic details, history of open appendectomy, and the clinical presentation were collected. The examination consisted of inspection, palpation, percussion, and auscultation and included various tests such as cough impulse and three-finger test. These findings were later confirmed with an ultrasound abdomen examination. Results: Among these 100 patients, 13 of them had the previous history of open appendectomy, all the study patients were male and they had the right direct inguinal hernia after 5 years of surgery. Among these 13 patients, 10 had perforated appendicitis, 2 had abscess, and 1 had purulent appendicitis. Among these 13, 11 of them had cosmetic Rutherford Morrison or Lanz incision and 2 of them had classical McBurney’s incision. Conclusion: The choice of the incision during open appendectomy is important and the surgeon should avoid injury to the ilioinguinal nerve motor branches which supplies the internal oblique and transverse abdominis muscles, care must be taken during surgery, especially below the horizontal line extending from the anterosuperior iliac spine to the rectus muscle.