Hemorrhagic risk factors and clinical management strategies in reoperation for recurrent inguinal hernias

doi:10.3877/cma.j.issn.1674-392X.2025.02.008

Abstract

Abstract:

Objective

To investigate the risk factors and management strategies for perioperative bleeding in recurrent inguinal hernia repair.

Methods

A retrospective case-control study was conducted, enrolling 57 patients who underwent surgical repair for recurrent inguinal hernia in The First Affiliated Hospital of Chongqing Medical University between January 2015 and December 2024.Patients were categorized into postoperative bleeding group (n=16) and non-bleeding group (n=41) based on the presence of bleeding-related complications (such as a significant drop in hemoglobin levels,excessive drainage, and hematoma/ecchymosis).Demographic data, previous surgical history, and preoperative and perioperative laboratory data were collected from the electronic medical records.Univariate and multivariate linear regression analyses were performed to identify risk factors associated with intraoperative blood loss, and multivariate logistic regression analysis was conducted to determine independent predictors of postoperative bleeding complications.

Results

The incidence of postoperative hemorrhagic complications (hemoglobin decline, increased drainage volume, hematoma/ecchymosis)following recurrent inguinal hernia repair was 28.1% (16/57).Multivariate linear regression revealed that intraoperative blood loss was significantly associated with body mass index(BMI) (β=5.072, P=0.020), and the consistency of surgical approach between initial and secondary procedures (β=-25.301, P=0.035).Multivariate logistic regression identified perioperative antithrombotic drug use as an independent risk factor for postoperative bleeding (OR=12.120, P=0.005), while intraoperative drainage tube placement served as a protective factor (OR=0.139, P=0.008).

Conclusion

Intraoperative bleeding risk in recurrent inguinal hernia repair is significantly influenced by the secondary surgical approach and BMI.Perioperative antithrombotic drug use and drainage tube placement are critical factors affecting postoperative hematoma complications.

Key words: Recurrent inguinal hernia, Surgical bleeding, Risk factors, Hemostatic strategy, Antithrombotic management

Gaoxiang Fan, Liwen Deng, Wei Song, Yu Zhao, Xuehu Wang. Hemorrhagic risk factors and clinical management strategies in reoperation for recurrent inguinal hernias[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(02): 160-166.

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Figures/Tables 4

组别	例数	男性[例(%)]	年龄(岁, $\overset{ˉ}{x}$ ± s )	BMI(kg/m² , $\overset{ˉ}{x}$ ± s )	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]	慢性肾脏病[例(%)]	COPD[例(%)]	脑梗史[例(%)]
出血组	16	15(93.8)	67.3±15.5	24.0±2.4	5(31.3)	1(6.3)	2(12.5)	0(0.0)	0(0.0)	2(12.5)
未出血组	41	39(95.1)	67.0±13.0	24.0±3.1	11(26.8)	1(2.4)	4(9.8)	2(4.9)	1(2.4)	1(2.4)
t/χ ² 值		-^a	-0.062	-0.038	0.000	-^a	0.000	-^a	-^a	-^a
P 值		1.000	0.951	0.970	0.995	0.486	1.000	1.000	1.000	0.187
组别	例数	腹部手术史[例(%)]	吸烟史[例(%)]	饮酒史[例(%)]	抗栓药物[例(%)]	初次手术补片使用[例(%)]	初次手术方式[例(%)]		Hb(g/L, $\overset{ˉ}{x}$ ± s )	PT(s, $\overset{ˉ}{x}$ ± s )	APTT(s, $\overset{ˉ}{x}$ ± s )
组别	例数	腹部手术史[例(%)]	吸烟史[例(%)]	饮酒史[例(%)]	抗栓药物[例(%)]	初次手术补片使用[例(%)]	腹腔镜手术	开放手术	Hb(g/L, $\overset{ˉ}{x}$ ± s )	PT(s, $\overset{ˉ}{x}$ ± s )	APTT(s, $\overset{ˉ}{x}$ ± s )
出血组	16	5(31.3)	7(43.8)	7(43.8)	7(43.8)	8(50.0)	3(18.8)	13(81.3)	138±16.2	13.4±0.9	37.0±4.3
未出血组	41	14(34.1)	19(46.3)	15(36.6)	3(7.3)	27(65.9)	14(34.1)	27(65.9)	138±18.2	13.5±0.6	36.7±3.8
t/χ ² 值		0.043	0.031	0.249	8.192	1.221	0.672		-0.045	0.345	-0.219
P 值		0.835	0.860	0.618	0.004	0.269	0.412		0.964	0.732	0.828

组别	例数	男性[例(%)]	年龄(岁, $\overset{ˉ}{x}$ ± s )	BMI(kg/m² , $\overset{ˉ}{x}$ ± s )	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]	慢性肾脏病[例(%)]	COPD[例(%)]	脑梗史[例(%)]
出血组	16	15(93.8)	67.3±15.5	24.0±2.4	5(31.3)	1(6.3)	2(12.5)	0(0.0)	0(0.0)	2(12.5)
未出血组	41	39(95.1)	67.0±13.0	24.0±3.1	11(26.8)	1(2.4)	4(9.8)	2(4.9)	1(2.4)	1(2.4)
t/χ ² 值		-^a	-0.062	-0.038	0.000	-^a	0.000	-^a	-^a	-^a
P 值		1.000	0.951	0.970	0.995	0.486	1.000	1.000	1.000	0.187
组别	例数	腹部手术史[例(%)]	吸烟史[例(%)]	饮酒史[例(%)]	抗栓药物[例(%)]	初次手术补片使用[例(%)]	初次手术方式[例(%)]		Hb(g/L, $\overset{ˉ}{x}$ ± s )	PT(s, $\overset{ˉ}{x}$ ± s )	APTT(s, $\overset{ˉ}{x}$ ± s )
组别	例数	腹部手术史[例(%)]	吸烟史[例(%)]	饮酒史[例(%)]	抗栓药物[例(%)]	初次手术补片使用[例(%)]	腹腔镜手术	开放手术	Hb(g/L, $\overset{ˉ}{x}$ ± s )	PT(s, $\overset{ˉ}{x}$ ± s )	APTT(s, $\overset{ˉ}{x}$ ± s )
出血组	16	5(31.3)	7(43.8)	7(43.8)	7(43.8)	8(50.0)	3(18.8)	13(81.3)	138±16.2	13.4±0.9	37.0±4.3
未出血组	41	14(34.1)	19(46.3)	15(36.6)	3(7.3)	27(65.9)	14(34.1)	27(65.9)	138±18.2	13.5±0.6	36.7±3.8
t/χ ² 值		0.043	0.031	0.249	8.192	1.221	0.672		-0.045	0.345	-0.219
P 值		0.835	0.860	0.618	0.004	0.269	0.412		0.964	0.732	0.828

组别	例数	此次补片类型[例(%)]		复发疝类型[例(%)]			麻醉方式[例(%)]
组别	例数	平片	3D补片	直疝	斜疝	股疝	气管插管全身麻醉	椎管内麻醉	局部麻醉
出血组	16	15(93.8)	1(6.3)	4(35.0)	12(75.0)	0(0.0)	10(62.5)	5(31.3)	1(6.3)
未出血组	41	37(90.2)	4(9.8)	16(39.0)	23(56.1)	2(4.9)	22(53.7)	16(39.0)	3(7.3)
t/χ ² 值		0.000			-^a			0.371
P值		1.000			0.478			0.831
组别	例数	此次手术方式[例(%)]		放置引流[例(%)]	术中出血量[ml, M(Q₁~Q₃)]	术后Hb(g/L, $\overset{ˉ}{x}$ ± s )	住院时间(d, $\overset{ˉ}{x}$ ± s )	术后疼痛[例(%)]
组别	例数	TAPP	Lichtenstein	放置引流[例(%)]	术中出血量[ml, M(Q₁~Q₃)]	术后Hb(g/L, $\overset{ˉ}{x}$ ± s )	住院时间(d, $\overset{ˉ}{x}$ ± s )	无疼痛	轻微疼痛	中度疼痛	重度疼痛
出血组	16	9(56.3)	7(43.8)	5(31.3)	17.5(10.0~45.0)	133±14.6	6.50±2.13	5(31.3)	9(56.3)	2(12.5)	0(0.0)
未出血组	41	12(29.3)	29(70.7)	30(73.2)	20.0(10.0~30.0)	138±16.3	7.37±3.22	4(9.8)	30(73.2)	6(14.6)	1(2.4)
t/χ ² 值		3.601		8.534	-0.532^b	-1.018	-0.993		-^a
P值		0.058		0.003	0.601	0.313	0.325		0.254

组别	例数	此次补片类型[例(%)]		复发疝类型[例(%)]			麻醉方式[例(%)]
组别	例数	平片	3D补片	直疝	斜疝	股疝	气管插管全身麻醉	椎管内麻醉	局部麻醉
出血组	16	15(93.8)	1(6.3)	4(35.0)	12(75.0)	0(0.0)	10(62.5)	5(31.3)	1(6.3)
未出血组	41	37(90.2)	4(9.8)	16(39.0)	23(56.1)	2(4.9)	22(53.7)	16(39.0)	3(7.3)
t/χ ² 值		0.000			-^a			0.371
P值		1.000			0.478			0.831
组别	例数	此次手术方式[例(%)]		放置引流[例(%)]	术中出血量[ml, M(Q₁~Q₃)]	术后Hb(g/L, $\overset{ˉ}{x}$ ± s )	住院时间(d, $\overset{ˉ}{x}$ ± s )	术后疼痛[例(%)]
组别	例数	TAPP	Lichtenstein	放置引流[例(%)]	术中出血量[ml, M(Q₁~Q₃)]	术后Hb(g/L, $\overset{ˉ}{x}$ ± s )	住院时间(d, $\overset{ˉ}{x}$ ± s )	无疼痛	轻微疼痛	中度疼痛	重度疼痛
出血组	16	9(56.3)	7(43.8)	5(31.3)	17.5(10.0~45.0)	133±14.6	6.50±2.13	5(31.3)	9(56.3)	2(12.5)	0(0.0)
未出血组	41	12(29.3)	29(70.7)	30(73.2)	20.0(10.0~30.0)	138±16.3	7.37±3.22	4(9.8)	30(73.2)	6(14.6)	1(2.4)
t/χ ² 值		3.601		8.534	-0.532^b	-1.018	-0.993		-^a
P值		0.058		0.003	0.601	0.313	0.325		0.254

变量	单因素回归结果		多因素回归结果
变量	β 值(95% CI)	P 值	β 值(95% CI)	P 值
性别	-45.074(-103.486~13.338)	0.128
年龄(岁)	-0.515(-1.490~0.461)	0.295
吸烟史	7.231(-19.448~33.910)	0.589
体重指数(kg/m^²)	7.039(2.838~11.241)	0.001	5.072(0.847~9.297)	0.020
APTT(s)	1.457(-2.025~4.940)	0.405
PT(s)	6.129(-12.235~24.494)	0.506
初次手术方式	25.656(-2.631~53.942)	0.075
复发疝时间	-0.058(-0.135~0.020)	0.143
抗栓药物使用	46.694(14.014~79.373)	0.006	29.291(-2.716~61.298)	0.072
不同入路	-33.292(-58.484~-8.099)	0.011	-25.301(-48.704~-1.899)	0.035

变量	单因素logistic 回归		多因素logistic 回归
变量	OR 值(95% CI)	P 值	OR 值(95% CI)	P 值
性别	0.769(0.065~9.123)	0.835
年龄(岁)	1.001(0.959~1.045)	0.950
体重指数(kg/m²)	1.004(0.822~1.226)	0.969
PT(s)	0.866(0.388~1.934)	0.726
APTT(s)	1.017(0.877~1.179)	0.824
吸烟史	0.901(0.281~2.881)	0.860
抗栓药	9.852(2.122~45.74)	0.003	12.120(2.105~69.778)	0.005
不同入路	2.604(0.792~8.567)	0.115
麻醉方式	0.826(0.311~2.191)	0.701
手术方式	0.322(0.097~1.063)	0.063
放置引流	0.167(0.047~0.589)	0.005	0.139(0.032~0.600)	0.008

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