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Updated: Mar 22, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Is preoperative withdrawal of aspirin necessary in patients undergoing elective inguinal hernia repair?
Wilson Ong1, Tong Shen2, Wee Boon Tan3
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. prooyf@hotmail.com.
Insights
Continuing aspirin perioperatively for inguinal hernia repair is safe. Aspirin continuation is recommended for patients with higher cardiovascular risk, showing no increased bleeding or major adverse cardiac events (MACE).
Area of Science:
- Cardiovascular Medicine
- Surgical Oncology
- Pharmacology
Background:
- Aspirin is crucial for preventing thrombotic events in patients with cardiovascular comorbidities.
- Continuing aspirin during non-cardiac surgery may reduce major adverse cardiac events (MACE) but can increase bleeding risks.
- No guidelines exist for perioperative aspirin use in inguinal hernia repair.
Purpose of the Study:
- To evaluate the safety of continuing aspirin perioperatively in patients undergoing elective primary inguinal hernia repair.
- To compare outcomes between patients who continued aspirin and those who stopped before surgery.
Main Methods:
- Retrospective analysis of 1841 patients undergoing elective primary inguinal hernia repair (2008-2015).
- Patients on preoperative aspirin were divided into two groups: continued aspirin or stopped 3-7 days prior.
- Outcomes included blood loss, operative time, bleeding, wound complications, and MACE.
Main Results:
- Of 142 patients on aspirin, 70 stopped and 72 continued.
- No significant differences in blood loss, operative time, bleeding, or wound complications were observed between groups.
- Major adverse cardiac events (MACE) and perioperative mortality were similar, with no MACE in laparoscopic cases.
Conclusions:
- Continuation of aspirin is safe in the perioperative period for elective primary inguinal hernia repair.
- Aspirin continuation is preferred for patients with higher cardiovascular risk.
- The study supports current practices for managing aspirin in this patient population.
Background:
Antiplatelets such as aspirin are widely used to reduce thrombotic events in patients with various cardiovascular comorbidities. Continuing aspirin through noncardiac surgery has been shown to reduce risk of major adverse cardiac events (MACE) but may lead to higher bleeding complications. Inguinal hernia repair is a commonly performed surgical procedure among such patients, but no guideline exists regarding perioperative use of aspirin.
Objective:
We aim to investigate the safety profile of aspirin continuation in the perioperative period in patients undergoing elective primary inguinal hernia repair.
Methods:
All patients who underwent elective primary inguinal hernia repair from 2008 to 2015 and were on aspirin preoperatively were identified. The patients were divided into two groups: those who continued aspirin through the morning of the operation and those who were advised to stop aspirin therapy 3-7 days prior to operation. All patients underwent either open Lichtenstein mesh repair or laparoscopic total extra-peritoneal mesh repair. Outcomes measured include intraoperative blood loss, operative time, bleeding complications, wound site complications and MACE.
Results:
Among 1841 patients who underwent elective primary inguinal hernia mesh repair, 142 (7.7 %) patients were on preoperative aspirin. Fifty-seven patients underwent laparoscopic repair, while 85 underwent open mesh repair. Twenty-seven out of fifty-seven (47.3 %) from the laparoscopic group and 55/85 (64.7 %) from the open group were instructed to stop aspirin (p = 0.040). There were no significant differences between those who stopped aspirin and those who continued in terms of intraoperative blood loss and operative timing. Immediate postoperative bleeding complications and follow-up wound complications were also similar between the two groups. Overall, there were no MACE among those who underwent laparoscopic repair. Three MACE were recorded in the open group (2 stopped vs. 1 continued; p = 0.943). There was no perioperative mortality.
Conclusion:
Continuation of aspirin is safe and should be preferred in patients with higher cardiovascular risk.
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