Background and Aims Amyand's hernia is a special type of inguinal hernia, and there is currently no uniform treatment standard. This study was conducted to provide a basis for reducing complications of this condition and improving prognosis of the patients by systematically evaluating its clinical characteristics and related surgical strategies.Methods The studies concerning Amyand's hernia in adults published since January 1, 2000 to date were collected by comprehensively searching several domestic and foreign online databases. After literature screening, relevant data extraction, bias assessment and crosschecking by two independent reviewers according to the inclusion and exclusion criteria, a systematic review was performed.Results A total of 141 studies were included involving 184 adult patients with Amyand's hernia, and the most majority of papers was contributed by the authors from China and the highest number of papers was published by the journal of Hernia, respectively. In terms of clinical features, male patients accounted for 91.8%, with a median onset age of 60 years, and the median onset age in women was 69 years; 89.1% of them had a right hernia and 8.9% had a recurrent hernia; a total of 75 patients failed to access the relevant information; the remaining 109 patients consisted of 104 indirect hernias, 4 direct hernias, and 1 saddle hernia; 25.7% of the patients were diagnosed before surgery, and the diagnostic accuracy of ultrasound, CT and their combination were 23.1% (6/26), 75.0% (33/44), and 62.5% (5/8), and one case was diagnosed by enema. With regard to the treatment, 42 patients underwent elective procedures, 122 cases received emergency operation, and 20 cases had no treatment information; 45.6% of cases underwent mesh repair, 50% of cases underwent endogenous repair, and 4.4% of cases did not undergo repair or delayed repair; 80.9% of cases underwent appendectomy and the appendix was preserved in remaining of them; there were Losanoff and Basson type 1 or 2 lesion in 140 cases and type 3 or 4 lesion in 35 cases verified by intraoperative findings, and 12 cases had combined appendix tumors. As for the outcomes, the median length of postoperative hospital stay was 4 d, a total of 125 patients were followed up with a median time of 6 months, and 17 cases had complications (6 cases of pulmonary infection or embolic disease, 5 cases of surgical site infection, 3 cases of seroma, 3 cases of recurrence, 1 case of urinary retention), all of them were emergency surgery patients.Conclusion The adult Amyand's hernia is a rare type of inguinal hernia, which is difficult to distinguish from the incarcerated or strangulated hernia. It usually requires an emergency surgery. The treatment of Amyand's hernia should be individualized based on intraoperative conditions, with the fundamental principle of avoiding the infection of the implanted mesh. Further basic and clinical research on Amyand's hernia should be encouraged for improving the treatment efficacy and the prognosis of the patients.