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Antiplatelet Therapy in Inguinal Hernia Repair: To Continue or Interrupt? A Systematic Review and Meta-Analysis
Augusto Graziani E Sousa1, Caroline Daleaste Wilmsen2, Júlia Copetti Burmann3
1Centro Universitário de Anápolis, Anápolis, Brazil.
Insights
Continuing antiplatelet therapy during inguinal hernia repair (IHR) is safe. This systematic review found no significant differences in surgical site occurrences, reoperations, or hernia recurrence rates between patients who continued or stopped antiplatelet agents.
Area of Science:
- General Surgery
- Pharmacology
- Evidence-Based Medicine
Background:
- Antiplatelet therapy is commonly used, but its role during inguinal hernia repair (IHR) remains debated.
- Concerns exist regarding potential increased bleeding complications with antiplatelet use during IHR.
Purpose of the Study:
- To conduct a comprehensive systematic review and meta-analysis.
- To evaluate the safety and efficacy of continuing antiplatelet therapy during IHR.
Main Methods:
- Systematic search of PubMed, Cochrane, and Embase databases.
- Meta-analysis of 5 studies involving 5610 patients undergoing IHR.
- Analysis of outcomes including hematoma, surgical site occurrences (SSOs), infection, reoperation, and hernia recurrence.
Main Results:
- No statistically significant differences were observed in hematoma, bruising, seroma, SSOs, operative time, or length of stay between groups.
- Rates of surgical site infection, readmission, and hernia recurrence were also comparable.
- Analysis included 5 studies with 5610 patients, primarily undergoing open repair.
Conclusions:
- Continuing antiplatelet therapy during IHR is safe and does not increase the risk of major adverse outcomes.
- The findings support current guidelines that may allow continuation of antiplatelet therapy in select patients undergoing IHR.
Introduction:
This study aims to perform a comprehensive systematic review and meta-analysis to evaluate the effect of antiplatelet therapy during inguinal hernia repair (IHR) and its respective outcomes.
Methods:
PubMed, Cochrane, and Embase were searched for studies comparing the use of antiplatelet agents in patients undergoing IHR. The results analyzed were hematoma, bruising, seroma, surgical site occurrences (SSOs), surgical site infection (SSI), operative time, length of stay (LOS), reoperation, hernia recurrence, and readmission. Statistical analysis was performed with Review Manager 5.4 using a random-effects model.
Results:
From 1588 records, 5 studies were included, encompassing 5610 patients (antiplatelet continuation n = 517), with 90% of patients submitted to open surgical repair and a mean follow-up time of 115 days. Overall analysis showed comparable results between groups regarding hematoma (risk ratio [RR]: 0.99; 95% confidence interval [CI]: 0.35 to 2.81; P = .98), bruising (RR: 1.89; 95% CI: 0.65 to 5.45; P = .24), seroma (RR: 1.00; 95% CI: 0.40 to 2.50; P = .99), SSO (RR: 1.09; 95% CI: 0.68 to 1.64; P = .72), reoperation (RR: 5.11; 95% CI: 0.62 to 42.26; P = .13), operative time (mean difference [MD] = 0.85 minutes; 95% CI: -0.47 to 2.16 minutes; P = .21), and LOS (MD = -0.28 days; 95% CI: -0.85 to 0.29 days; P = .34). Additionally, no statistically significant results were seen for SSI (RR: 0.39; 95% CI: 0.02 to 9.16; P = .56), readmission (RR: 0.46; 95% CI: 0.10 to 2.18; P = .32), and hernia recurrence rates (RR: 2.73; 95% CI: 0.25 to 29.45; P = .41).
Conclusion:
Antiplatelet therapy during IHR is safe and associated with comparable results between groups for SSO, reoperation, operative time, LOS, SSI, readmission, and hernia recurrence rates.
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