To evaluate the clinical safety of tension-free repair of inguinal hernia under local anesthesia in patients without interruption of antithrombotic drugs in perioperative period.

A prospective cohort study was conducted to investigate the effects of perioperative continuation of oral antiplatelets or anticoagulants on inguinal hernioplasty patients admitted to West China Hospital of Sichuan University from September 2018 to March 2020. The experimental group continued to take antithrombotic drugs during the perioperative period, whereas the control group consisted of patients who served as age, sex, BMI and the Rutkow classification matched controls underwent inguinal hernia repair without history of oral antithrombotic drugs. The patients of two groups underwent tension-free hernia repair under local infiltration anesthesia by the same surgeon. The surgical situation, length of stay, incision complications, bleeding and thromboembolic complications were compared between the two groups. T-test, Mann-Whitney U-test, Chi-square test or Fisher exact test were used to analyze the results.

A total of 148 patients were enrolled, including 74 patients in the experimental group (14 patients on warfarin therapy, 3 patients on new oral anticoagulant therapy, 36 patients on aspirin therapy, 13 patients on clopidogrel therapy, 1 patient on ticagrelor therapy, and 7 patients on dual aspirin and clopidogrel therapy), and 74 patients in the control group. There was no significant difference in age, gender, BMI, Rutkow classification of inguinal hernia, operation time, intraoperative bleeding and hospitalization days between the experimental group and the control group (P>0.05). Preoperative blood INR, PT and APTT of experimental groups were significantly longer than the control group (P<0.05). In the experimental group, a case had postoperative subcutaneous wound hematoma (without blood transfusion and reoperation), and 4 cases had poor wound healing, one case had scrotal edema, whereas in the control group, 3 cases of poor wound healing were observed. They were resolved with basic conservative managements. We have not observed statistically significant difference between the two groups with regards to postoperative complications (P>0.05). No incidences of perioperative thromboembolic events were observed.

Tension-free inguinal hernioplasty under local anesthesia can be safely performed in patients with long-term oral antithrombotic drugs. Uninterrupted antithrombotic therapy does not increase the risk of intraoperative bleeding and postoperative hemorrhagic events compared with patients without antithrombotic drugs.