Has endoscopic (TEP, TAPP) or open inguinal hernia repair a higher risk of bleeding in patients with coagulopathy or antithrombotic therapy? Data from the Herniamed Registry

Abstract

Introduction 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. To date, there is a paucity of concrete data on this important clinical aspect of inguinal hernia surgery. Up till now, the endoscopic (TEP, TAPP) techniques have been considered to be more risky because of the extensive dissection involved.Patients and methodsOut 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. The implications of that risk profile for onset of postoperative bleeding were investigated in multivariable analysis. In addition, other influence variables were identified.ResultsThe 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). Multivariable analysis revealed other influence variables which, in addition to coagulopathy or antithrombotic therapy, had a relevant influence on the occurrence of postoperative bleeding. These were open operation, a higher age, a higher ASA score, recurrence, male gender and a large hernia defect.SummaryPatients receiving antithrombotic therapy or with existing coagulopathy who undergo inguinal hernia operation have a fourfold higher risk for onset of postoperative secondary bleeding. 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.

Single‐incision totally extraperitoneal inguinal hernia repair is feasible and safe in patients on antithrombotic therapy: A single‐center experience of 92 procedures

“…A previous report showed that patients receiving antithrombotic therapy or with existing coagulopathy who had undergone inguinal hernia operation have a fourfold higher risk (3.9%) for postoperative secondary bleeding . In the present study, preperitoneal dissection was performed gradually from the space under the intraumbilical skin incision with standard laparoscopic instruments, such as laparoscopic coagulation shears and blunt dissectors, because blind balloon dilation of the preperitoneal space could have caused intraoperative bleeding and a poor operative field.…”

Does coagulopathy, anticoagulant or antithrombotic therapy matter in incisional hernia repair? Data from the Herniamed Registry

“…Regarding inguinal hernia surgery alone, postoperative bleeding is the most frequent adverse event [16, 17]. A recent registry-based analysis of 82,911 patients undergoing open or endoscopic [transabdominal preperitoneal patch plasty (TAPP), total extraperitoneal patch plasty (TEP)] inguinal hernia repair showed a fourfold higher risk for onset of postoperative bleeding in patients with existing anticoagulation or antithrombotic therapy [10]. Surprisingly, the endoscopic procedures (TAPP, TEP) showed lower postoperative bleeding rates compared to open inguinal hernia repair, although the endoscopic techniques were deemed as being more likely to cause postoperative bleeding due to their more extensive tissue dissection.…”

“…Surprisingly, the endoscopic procedures (TAPP, TEP) showed lower postoperative bleeding rates compared to open inguinal hernia repair, although the endoscopic techniques were deemed as being more likely to cause postoperative bleeding due to their more extensive tissue dissection. Additionally, larger hernia defect size, male gender, higher ASA score, and recurrent operation were identified as significant risk factors for postoperative bleeding in the registry population [10]. However, data on the risk of postoperative bleeding among patients undergoing incisional hernia repair are rare.…”

“…Omitting antiplatelet medication prior to surgery or discontinuing oral anticoagulation therapy with heparin bridging may help to control the risk of postoperative bleeding after inguinal hernia surgery [8, 9]. However, a recent registry-based study showed a fourfold increase in postoperative bleeding following open and endoscopic inguinal hernia repair in patients with antiplatelet medication or anticoagulation [10], highlighting the need for careful perioperative anticoagulation management in hernia patients.…”

Die evidenzbasierte TEP-Technik

“…B. Thrombozytenaggregationshemmern nicht möglich, kann bei sorgfältiger Präparation und Blutstillung dennoch laparoendoskopisch operiert werden. Registerdaten zeigen, dass das laparoendoskopische Operieren im Vergleich zum offenen kein erhöhtes Risiko für Nachblutungen darstellt [5].…”