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

• Published in: Surgical endoscopy Vol. 36; no. 12; pp. 9011 - 9018
• Main Authors: Balch, Jeremy A., Neal, Dan, Crippen, Cristina, Johnson-Mann, Crystal N., Read, Thomas E., Loftus, Tyler J., Al-Mansour, Mazen R.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Anticoagulants; Anticoagulants - adverse effects; Aspirin; Aspirin - adverse effects; Female; Fibrinolytic Agents - adverse effects; Gastroenterology; Gynecology; Hepatology; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Proctology; Retrospective Studies; Surgery; Antiplatelet; Antithrombic; Anticoagulation; Laparoscopic hernia repair; Inguinal hernia repair
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09360-1

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.