Dear Sir, We read with interest the article published in your journal by Sharma H et al. [1]. The authors present results from a large group with Amyand’s hernia. They conclude that the inXammatory status of the appendix determines the surgical approach and the type of hernia repair, with or without the use of an alloplastic mesh. As reported in literature [2, 3], use of a synthetic mesh should be avoided because of the high risk of infection. We report a case successfully treated by simultaneous appendectomy and mesh repair. A man of 62 was referred with diagnosis of incarcerated right inguinal hernia. We decided on a surgical open approach. The groin was explored through anterior access. After opening of the external oblique aponeurosis we found an important abscess rising from the internal ring. We drained the purulent material accurately and isolated a sliding hernia. The sac contained the caecum and the perforated gangrenous appendix, both incarcerated in the deep ring. We continued with the appendectomy and irrigation of the peritoneum and the inguinal area with antibiotics. The caecum was freed from adhesion to the sac and reduced into the abdominal cavity. We then resected the previously ligated sac. We decided to repair the inguinal defect, given the presence of intense inXammation and tissutal edema, positioning the PAD complex, a polypropylene Xat mesh that we routinely use to repair primitive inguinal hernias in our department, over the transversalis fascia [4]. Two Redon drainages were left below the aponeurosis, one in direction of the deep ring and the other along the spermatic cord in direction of scrotum; these were removed on seventh postoperative day. We administered postoperative intravenous metronidazole, 500 mg three times a day for 4 days, and piperacillin/tazobactam, 4.5 g three times a day, for 8 days, to the patient. On eighth postoperative day the patient was discharged asymptomatic. One-month and sixmonth follow-ups revealed no problem. In cases of perforated appendicitis in the hernial sac it may seem very hazardous deciding for a mesh repair after appendicectomy [5, 6]. The recommended direct suture using Shouldice’s or Bassini’s procedures could be technically very diYcult in an inXamed and edematous area, however, and could increase the risk of recurrence. We believe use of a synthetic mesh is feasible and safe enough if the inguinal area has previously been accurately irrigated with antibiotics, a drain is placed under the aponeurosis, and the patient is treated postoperatively with intravenous antibiotics. Use of inert materials, for example polypropylene, is, moreover, important, in our opinion, to minimize the risk of infections, as well as plain type protheses are useful to avoid the creation of empty spaces and porousness of the protheses that could make it easy to drain the infection. In our opinion, the presence of pus or perforation of the appendix is not an absolute contraindication to positioning of a mesh for hernia repair, which remains a valid alternative when a direct hernia repair seems diYcult to perform. G. Torino (&) Pediatric Surgery Unit, Policlinico Umberto I, University “La Sapienza”, Viale Del Policlinico 155, 00161 Rome, Italy e-mail: giovannitorino@interfree.it