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Safety of laparoscopic inguinal hernia repair in the setting of antithrombotic therapy

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Abstract

Introduction

There are a paucity of data regarding the safety of laparoscopic inguinal hernia repair in patients on antiplatelet and anticoagulant therapy (APT/ACT). We aim to compare the postoperative outcomes of laparoscopic (LIHR) vs. open repair of inguinal hernias (OIHR) in patients on APT/ACT.

Method

We conducted a retrospective cohort study using the Vizient Clinical DataBase. We included adults receiving APT/ACT who underwent outpatient, elective, and primary inguinal hernia repair between 2017 and 2019. Subgroup analysis was performed on patients receiving aspirin, non-aspirin antiplatelet, and anticoagulant therapy. Mixed-effects logistic regression was used to assess both the effect of APT/ACT on the probability of receiving LIHR vs OIHR and their respective outcomes.

Result

A total of 142,052 repairs were included, of which 21,441 (15%) were performed on patients receiving APT/ACT. Mean age was 69 years (± 10.5) and 93% were male. 19% of hernias were bilateral. 40% of operations were performed at teaching hospitals. On multivariable analysis, patients on non-aspirin antiplatelet or anticoagulant therapy were more likely to receive an open procedure (Odds Ratio (OR) = 1.2; 95% Confidence Intervals (CI) [1.1, 1.4] and OR = 1.4; CI [1.3, 1.5], respectively). LIHR was associated with a lower rate of length of stay > 1 day (OR = 0.65; CI [0.5, 0.9]). Rates of 30-day postoperative hematoma, transfusions, stroke, myocardial infarction, deep venous thrombosis, pulmonary embolism, readmission, and emergency department visits were similar between the two operative approaches.

Conclusion

Patients on APT/ACT represent a substantial proportion of those undergoing inguinal hernia repair. Non-aspirin antiplatelet or anticoagulant therapy are independent predictors of choosing an open repair. Laparoscopic repair appears to be safe in patients receiving APT/ACT under current perioperative management patterns.

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Acknowledgements

We would like to acknowledge the staff at Vizient for their provision of the data and technical support.

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Authors and Affiliations

  1. Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA

    Jeremy A. Balch, Dan Neal, Cristina Crippen, Crystal N. Johnson-Mann, Thomas E. Read, Tyler J. Loftus & Mazen R. Al-Mansour

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  1. Jeremy A. Balch
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  2. Dan Neal
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  3. Cristina Crippen
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  7. Mazen R. Al-Mansour
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Correspondence to Mazen R. Al-Mansour.

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Disclosures

Mazen Al-Mansour has received educational payments from Intuitive Surgical, Inc. and general payments (food and beverage) from W. L Gore & Associated, Inc. and ConMed Corporation. Jeremy A. Balch, Dan Neal, Cristina Crippen, Crystal N. Johnson-Mann, Thomas E. Read, and Tyler J. Loftus have no disclosures to report.

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Balch, J.A., Neal, D., Crippen, C. et al. Safety of laparoscopic inguinal hernia repair in the setting of antithrombotic therapy. Surg Endosc 36, 9011–9018 (2022). https://doi.org/10.1007/s00464-022-09360-1

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  • DOI: https://doi.org/10.1007/s00464-022-09360-1

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