That calls for careful perioperative risk/benefit assessment with regard to the use of such therapeutics. Prophylactic or therapeutic use of anticoagulants and platelet aggregation inhibitors confronts the treating surgeon with the challenge of protecting patients against thromboembolic complications without inducing bleeding complications. Because antithrombotic agents are associated with longer bleeding time, the risk of postoperative hemorrhage is increased. Therefore, it is not uncommon for the patients to be on antiplatelet or anticoagulant therapy. Despite the extensive dissection required for endoscopic (TEP, TAPP) inguinal hernia repair, the risk of bleeding complications and complication-related reoperation appears to be lower.Īgainst a background of a progressively aging population, candidates for inguinal hernia repair are often elderly and have comorbidities. Patients receiving antithrombotic therapy or with existing coagulopathy who undergo inguinal hernia operation have a fourfold higher risk for onset of postoperative secondary bleeding. These were open operation, a higher age, a higher ASA score, recurrence, male gender and a large hernia defect. Multivariable analysis revealed other influence variables which, in addition to coagulopathy or antithrombotic therapy, had a relevant influence on the occurrence of postoperative bleeding. The rate of postoperative secondary bleeding, at 3.91 %, was significantly higher in the risk group with coagulopathy or receiving antithrombotic therapy than in the group without that risk profile at 1.12 % ( p < 0.001). In addition, other influence variables were identified. The implications of that risk profile for onset of postoperative bleeding were investigated in multivariable analysis.
Out of the 82,911 patients featured in the Herniamed Hernia Registry who had undergone inguinal hernia repair, 9115 (11 %) were operated on while receiving antithrombotic therapy or with existing coagulopathy. Up till now, the endoscopic (TEP, TAPP) techniques have been considered to be more risky because of the extensive dissection involved. To date, there is a paucity of concrete data on this important clinical aspect of inguinal hernia surgery. Inguinal hernia operations in the presence of antithrombotic therapy, based on antiplatelet or anticoagulant drugs, or existing coagulopathy are associated with a markedly higher risk for onset of postoperative secondary bleeding.
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