Abstract:

Objective

To investigate and analyze the factors associated with postoperative hemorrhage following laparoscopic inguinal hernia repair (LIHR).

Methods

A retrospective analysis was conducted on the clinical data of 2010 patients who underwent LIHR at the Second Affiliated Hospital of Soochow University from September 1, 2019 to August 31, 2024.Factors including patients' general characteristics, surgical method, surgical site, timing of surgery, history of diabetes, preoperative use of anticoagulants, hernia sac size, history of radical prostatectomy, and recurrent hernia after LIHR were analyzed for their association with postoperative hemorrhage.Chi-square tests were used for univariate analysis to identify potential risk factors, followed by binary logistic regression to evaluate independent risk factors.Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results

Among the 2010 patients who underwent LIHR, 32 cases (1.59%) experienced postoperative hemorrhage.Of these, 29 were successfully treated with conservative methods, while 3 cases required secondary laparoscopic surgery due to massive bleeding.The intraoperative causes of bleeding included active vascular bleeding from the hernia sac in large hernias, corona mortis vascular injury, and spermatic vessel bleeding.Univariate analysis showed that preoperative use of anticoagulants, hernia sac size (≥5 cm), history of radical prostatectomy, and recurrent hernia after LIHR were significantly associated with postoperative hemorrhage (P＜0.05).Logistic regression confirmed these as independent risk factors, with ORs of 4.289(95% CI 1.882-9.775, P＜0.001), 2.840 (95% CI 1.375-5.866, P=0.005), 4.071 (95% CI 1.644-10.078,P=0.002), and 9.639 (95% CI 4.000-23.230, P＜0.001), respectively.

Conclusion

Preoperative use of anticoagulants, hernia sac size ≥5 cm, history of radical prostatectomy, and recurrent hernia after LIHR were independent risk factors for postoperative hemorrhage.Intraoperative vascular injury and improper handling were also important causes of postoperative bleeding.Clinical strategies should focus on preventive measures targeting these risk factors and enhancing intraoperative procedural standards to reduce the risk of postoperative hemorrhage.

Key words: Hernia, inguinal, Laparoscopy, Hernia repair, Postoperative hemorrhage, Vascular injury