Antiplatelet Therapy in Inguinal Hernia Repair: To Continue or Interrupt? A Systematic Review and Meta-Analysis

Abstract

Introduction:

This study aims to perform a comprehensive systematic review and meta-analysis to evaluate the effect of antiplatelet therapy during inguinal hernia repair (IHR) and its respective outcomes.

Methods:

PubMed, Cochrane, and Embase were searched for studies comparing the use of antiplatelet agents in patients undergoing IHR. The results analyzed were hematoma, bruising, seroma, surgical site occurrences (SSOs), surgical site infection (SSI), operative time, length of stay (LOS), reoperation, hernia recurrence, and readmission. Statistical analysis was performed with Review Manager 5.4 using a random-effects model.

Results:

From 1588 records, 5 studies were included, encompassing 5610 patients (antiplatelet continuation n = 517), with 90% of patients submitted to open surgical repair and a mean follow-up time of 115 days. Overall analysis showed comparable results between groups regarding hematoma (risk ratio [RR]: 0.99; 95% confidence interval [CI]: 0.35 to 2.81; P = .98), bruising (RR: 1.89; 95% CI: 0.65 to 5.45; P = .24), seroma (RR: 1.00; 95% CI: 0.40 to 2.50; P = .99), SSO (RR: 1.09; 95% CI: 0.68 to 1.64; P = .72), reoperation (RR: 5.11; 95% CI: 0.62 to 42.26; P = .13), operative time (mean difference [MD] = 0.85 minutes; 95% CI: −0.47 to 2.16 minutes; P = .21), and LOS (MD = −0.28 days; 95% CI: −0.85 to 0.29 days; P = .34). Additionally, no statistically significant results were seen for SSI (RR: 0.39; 95% CI: 0.02 to 9.16; P = .56), readmission (RR: 0.46; 95% CI: 0.10 to 2.18; P = .32), and hernia recurrence rates (RR: 2.73; 95% CI: 0.25 to 29.45; P = .41).

Conclusion:

Antiplatelet therapy during IHR is safe and associated with comparable results between groups for SSO, reoperation, operative time, LOS, SSI, readmission, and hernia recurrence rates.