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Abstract Background Amyand’s hernia (AH) is defined as protrusion of the vermiform appendix within the sac of the inguinal hernia and usually misdiagnosed as obstructed hernia. It is more common in pediatric patients but there are controversies about dealing with the normally looking appendix in AH. The aim of this study is to present our experience in the management of AH and highlights the difference in dealing with normally looking appendix between pediatric and adult patients. Patients’ demographics, intraoperative, and postoperative outcome were reported and analyzed. Results This is a retrospective analysis of 12 pediatric patients aged between 15 days and 5 years presented with AH and operated in tertiary referral hospital over 10 years. This study included 10 males and 2 females. The median age at the operation was 7 months. Eleven patients were operated using conventional technique, and only one patient was operated using laparoscopy. In 11 patients, the appendix was looking normal and was reduced without appendectomy, and the hernia was repaired. Appendectomy was done in one patient presented with AH containing inflamed appendix. The postoperative course was uneventful in all cases. Conclusions There is a difference in the management of pediatric and adult patients presenting with AH, and appendectomy is not mandatory in normally looking appendix in pediatric patients.

Abstract Background This study aimed to compare the duration of postoperative analgesia using intraperitoneal bupivacaine plus neostigmine or bupivacaine alone. In this randomized controlled trial, we included 56 adult patients scheduled for elective laparoscopic cholecystectomy operation. Patients were randomly allocated into two groups bupivacaine group (B group) who received 50 ml bupivacaine 0.25% alone and bupivacaine-neostigmine group (BN group) who received 500 μg neostigmine added to 50 ml bupivacaine 0.25%. The study drug was instilled intraperitoneal according to group allocation before the start of the surgery. Primary outcome was the duration of analgesia. Other outcome included total dose of postoperative analgesic consumption and postoperative nausea and vomiting. Results Patients in BN group showed longer duration of analgesia after surgery and longer time for 1st analgesic dose than the patients in B group. Total dose of postoperative pethidine and the incidence of postoperative nausea and vomiting were lower in number in the BN group than in the B group. Conclusions Intraperitoneal instillation of neostigmine as an adjunct to bupivacaine in elective laparoscopic cholecystectomy increased the duration of postoperative analgesia. Also, it might reduce postoperative pain and analgesic requirements as compared to bupivacaine 0.25% alone. Trial registration Name of the registry: Clinical trial Clinical Trial registration number: NCT04244097 Date of registration: 28 January 2020 URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT04244097