Abstract:

Objective

Based on the concept of enhanced recovery after surgery （ERAS）， to investigate the safety of laparoscopic inguinal hernia repair （LIHR） in elderly patients receiving antithrombotic therapy （ATT）.

Methods

This was a retrospective cohort study. Clinical data of 413 elderly patients who underwent inguinal hernia repair in the First Hospital of Lanzhou University from January 2021 to September 2024 were retrospectively analyzed. Patients were divided into two groups according to perioperative ATT use：124 patients who received ATT in the ATT group and 289 patients who did not receive ATT in the non-ATT group. The primary outcomes were postoperative bleeding complications， classification of complication intervention measures （Clavien-Dindo classification）， and postoperative thromboembolic complications. Secondary outcomes included non-bleeding complications，operation time， and postoperative hospital stay. Subgroup analyses were further conducted within the ATT group based on drug types， and postoperative outcomes between open and laparoscopic surgeries in the ATT group were compared.

Results

No significant intraoperative bleeding （＞10 ml） occurred in either group. There were no statistically significant differences in postoperative bleeding complications between the two groups：ecchymosis （1.6% vs. 0.0%， P=0.09） and bloody exudation on dressings （6.5% vs. 5.9%，P=0.824）， with no hematoma observed. The intervention measures required for complications（Clavien-Dindo grade I：5.6% vs. 4.5%） between the ATT group and the non-ATT group showed no significant difference （P=0.619）. No postoperative thromboembolic complications occurred within 30 days in either group， and there were no significant differences in non-bleeding complications， intraoperative blood loss， or operation duration between the two groups （P＞0.05）. The postoperative hospital stay was significantly longer in the ATT group than in the non-ATT group （P＜0.001）. Subgroup analysis showed that the postoperative hospital stay ［M （Q₁， Q₃）］was 1.5 （1.0， 2.0） days in both the aspirin group and other antiplatelet drug groups， 2.0 （1.5， 2.0） days in the anticoagulant group， and 1.8 （1.0， 2.1） days in the multiple antithrombotic drug group， with significant differences among different drug groups （P=0.021）.For bloody exudation on dressings， there were 2 cases （3.4%） in the aspirin monotherapy group， 0 cases（0%） in other antiplatelet drug groups， 1 case （4.0%） in the anticoagulant group， and 5 cases （22.7%） in the multiple antithrombotic drug group， with significant differences among different drug groups （P=0.019）.No significant differences were found in other outcome indicators among subgroups （all P＞0.05）.Comparison of surgical approaches showed that the postoperative hospital stay was 2.0 （1.5， 2.0） days for open surgery and 1.5 （1.0， 2.0） days for laparoscopic surgery， with a statistically significant difference（P＜0.001）， while other outcomes showed no significant differences between the two groups （P＞0.05）.

Conclusion

A considerable proportion of elderly patients undergoing inguinal hernia repair receive ATT.Based on ERAS， LIHR is safe for elderly patients on monotherapy antiplatelet agents， while those on dual/multiple antiplatelet or combined anticoagulant therapies require cautious management to avoid postoperative bleeding complications.

Key words: Hernia, inguinal, Laparoscopic, Herniorrhaphy, Antithrombotic therapy, Enhanced recovery after surgery