Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy

Hada, Gonish; Zhang, Sen; Song, Yinghan; Jaiswar, Mukesh; Xie, Yanyan; Jian, Fushan; Lei, Wenhua

doi:10.1159/000509895

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…We reported a higher operative time (17 ± 47.2 minutes) and length of hospitalization (2.42 ± 3.48 days) than has been reported in the literature [10,12,17,18]. Our hospital admission policy and the fact that it is an educational institution can explain this difference.…”

Section: Discussionmentioning

confidence: 41%

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

Akeel¹

2021

Cureus

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Although inguinal hernia (IH) repair is low-risk surgery, older patients are occasionally offered watchful waiting because of their functional status and comorbidities. This study reviewed the surgical outcomes of IH repair in older patients in comparison with outcomes in younger patients. MethodsThis retrospective study included all patients who had IH repair from 2010 to 2020. The primary outcomes of interest were postoperative complications and recurrence. ResultsA total of 262 patients underwent IH repair during the study period; 40% were ≥60 years old. One patient had a recurrence. Among the 8% of patients who had postoperative complications, groin pain was the most common one (1.9%). Female patients had a significantly higher rate of complications than male patients did (38.5% female versus 6.4% male, p<0.001). The rate of complications was also higher for emergency surgery than for elective surgery (22.6% emergency versus 6.1% elective, p<0.001), as well for patients who needed concomitant bowel resection compared with those who did not. Patients who had emergency surgery or postoperative complications had a prolonged hospital stay. ConclusionsIH repair in older patients is low-risk surgery, comparable to that in younger patients. In this study, emergency surgery was more common in older than in younger patients and posed a higher risk of complications. We recommend offering elective hernia repair to older patients to avoid the higher complication rate associated with emergency repair.

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Section: Discussionmentioning

confidence: 41%

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

Akeel¹

2021

Cureus

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“…The risk of complications after hernia repair in relation to antithrombotic therapy has been investigated in a few studies, which were mainly focused on interventions entailing extensive dissection, i.e., pre-peritoneal (TEP) or trans-peritoneal (TAPP) laparoscopy. Although the treatment schedule differed in the type of drugs administered and suspension time between studies, most of them reported no differences with respect to wound infection, seroma, hematoma, and/or hernia recurrence between control and treated patients [29][30][31][32][33][34][35]. However, large-case surveys documented a higher frequency of postoperative bleeding and perioperative complications in patients taking antithrombotic therapy [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Sutureless Repair for Open Treatment of Inguinal Hernia: Three Techniques in Comparison

Baldini,

Lori,

Morini

et al. 2024

JCM

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Currently, groin hernia repair is mostly performed with application of mesh prostheses fixed with or without suture. However, views on safety and efficacy of different surgical approaches are still partly discordant. In this multicentre retrospective study, three sutureless procedures, i.e., mesh fixation with glue, application of self-gripping mesh, and Trabucco’s technique, were compared in 1034 patients with primary unilateral non-complicated inguinal hernia subjected to open anterior surgery. Patient-related features, comorbidities, and drugs potentially affecting the intervention outcomes were also examined. The incidence of postoperative complications, acute and chronic pain, and time until discharge were assessed. A multivariate logistic regression was used to compare the odds ratio of the surgical techniques adjusting for other risk factors. The application of standard/heavy mesh, performed in the Trabucco’s technique, was found to significantly increase the odds ratio of hematomas (p = 0.014) and, most notably, of acute postoperative pain (p < 0.001). Among the clinical parameters, antithrombotic therapy and large hernia size were independent risk factors for hematomas and longer hospital stay, whilst small hernias were an independent predictor of pain. Overall, our findings suggest that the Trabucco’s technique should not be preferred in patients with a large hernia and on antithrombotic therapy.

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“…For example, Hill and colleagues published in 2019 that the laparoscopic procedure under antiplatelet therapy does not have a relevant, higher risk profile than open surgery [ 19 ]. Particularly regarding older patients on antithrombotic therapy, Hada and colleagues were able to show it too, there is no increase in the risk of postoperative complications [ 20 ]. And even though Staerkle and colleagues found an increased risk for bleeding complications under antithrombotic therapy according to data from the Herniamed registry, the complication-related reoperations seemed to be lower in the laparoscopic approach [ 21 ], which as once more confirmed by Köckerling and colleagues, as well [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for early and late morbidity in patients with cardiovascular disease undergoing inguinal hernia repair with a tailored approach: a single-center cohort study

et al. 2023

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Background Inguinal hernia repair is a common procedure in surgery. Patients with cardiovascular disease have an increased operative risk for postoperative morbidity. The study aimed to identify the most beneficial surgical procedure for these patients. Methods Patients undergoing elective surgery for unilateral or bilateral inguinal hernia between December 2015 and February 2020 were included. The cohort was divided into the group of patients with (CVD group) and without (NO group) cardiovascular disease and analyzed according to the postoperative morbidity distribution and correlated to the surgical technique used. Results Of the 474 patients included 223 (47%) were operated on using the Lichtenstein technique and 251 (53%) using TAPP, respectively. In the CVD group the Lichtenstein procedure was more common (n = 102, 68.9%), in the NO group it was TAPP (n = 205, 62.9%; p < 0.001). 13 (8.8%) patients in the CVD group and 12 (3.7%) patients in the NO group developed a postoperative hematoma (p = 0.023). In the further subgroup analysis within the CVD group revealed cumarine treatment as a risk factor for postoperative hematoma development, whereas the laparoscopic approach did not elevate the morbidity risk. Conclusion CVD is a known risk factor for perioperative morbidity in general surgery, however, the TAPP method does not elevate the individual perioperative risk.

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Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy

Cited by 3 publications

References 32 publications

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

Sutureless Repair for Open Treatment of Inguinal Hernia: Three Techniques in Comparison

Risk factors for early and late morbidity in patients with cardiovascular disease undergoing inguinal hernia repair with a tailored approach: a single-center cohort study

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