The Influence of Differences in Surgical Access on the Development of Early Asymptomatic DVT After Inguinal Hernia Surgery

Abstract

Objective

This study aimed to examine the effect of surgical approach on the incidence of early asymptomatic deep vein thrombosis (DVT) following inguinal hernia surgery and to evaluate additional factors influencing postoperative asymptomatic DVT formation. The study seeks to provide guidance and support for the diagnosis and treatment of early postoperative asymptomatic DVT.

Methods

The present study is a retrospective study. Our study finally included 565 patients with inguinal hernia divided into laparoscopic and open surgery groups. Bilateral lower extremity venous Doppler ultrasonography was performed on the second postoperative day to document the occurrence of asymptomatic DVT in the early postoperative period. A 1:1 matching was performed using propensity score matching (PSM). Independent factors affecting early postoperative asymptomatic DVT were determined using multivariate binary logistic regression analysis.

Results

There were 565 patients, in which 317 underwent laparoscopic surgery and 248 underwent open surgery. Propensity score matching yielded 102 matched pairs for further analysis. In multivariate analysis, bilateral hernias (OR = 50.546, 95% CI 2.277-1122.159, P = 0.013) and total length of stay (OR = 1.807, 95% CI 1.239-2.634, P = 0.002) were identified as independent risk factors for early postoperative asymptomatic DVT, whereas preoperative length of stay (OR = 0.341, 95% CI 0.162-0.719, P = 0.005) and operation time (OR = 0.965, 95% CI 0.936-0.995, P = 0.021) served as protective factors. There was no significant impact of laparoscopic or open surgery on the incidence of early postoperative asymptomatic DVT (OR = 1.808, 95% CI: 0.288-11.361, P = 0.528).

Conclusion

The choice of laparoscopic vs open inguinal hernia repair did not significantly affect the incidence of early postoperative asymptomatic DVT. In this study, effective perioperative management, whether through preoperative admission to manage significant comorbidities or a reduced overall length of stay, lowered the incidence of early postoperative asymptomatic DVT, particularly in patients with bilateral inguinal hernias.