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.
BACKGROUND
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.


METHODS
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. The implications of that risk profile for onset of postoperative bleeding were investigated in multivariable analysis. In addition, other influence variables were identified.


RESULTS
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). 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. Patients 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.
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
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Köckerling
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
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Roessing
StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany.
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Adolf
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
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Schug-Pass
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstraße 6, 13585, Berlin, Germany.
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Jacob
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001317:Austria / Q000453:epidemiology; D001778:Blood Coagulation Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003374:Coumarins / Q000627:therapeutic use; D004210:Dissection / Q000009:adverse effects; D005260:Female; D005858:Germany / Q000453:epidemiology; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D019934:International Normalized Ratio; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012306:Risk; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D014945:Wound Healing
D000925:Anticoagulants; D003374:Coumarins; D010975:Platelet Aggregation Inhibitors; C030123:coumarin
Antithrombotic therapy; Bleeding complication; Coagulopathy; Inguinal hernia repair; TAPP; TEP