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Continuation of low-dose acetylsalicylic acid during perioperative period of laparoscopic inguinal hernia repair is safe: results of a prospective clinical trial

  • Z. Yan
  • Y. Liu
  • R. Ruze
  • Y. Xiong
  • H. Han
  • H. Zhan
  • M. Wang
  • G. ZhangEmail author
Original Article



Patients taking acetylsalicylic acid are common in surgical departments; in most cases, acetylsalicylic acid is discontinued 5–7 days before the operation to minimize the intra- and postoperative bleeding, but the perioperative management of patients under antithrombotic and anticoagulative treatments is controversial. This study aims to address whether the low-dose acetylsalicylic acid increases bleeding and occurrence of postoperative complications after laparoscopic inguinal hernia repair when it was only ceased on the operation day.


From July 2017 to January 2019, 901 patients including 781 (86.7%) male and 120 (13.3%) female patients underwent laparoscopic inguinal hernia repair using trans-abdominal preperitoneal (TAPP) technique were recruited, among whom 152 (16.9%) had been taking low-dose (100 mg per day) acetylsalicylic acid which was continued during hospitalization except the operation day. The intra-operative bleeding volume, postoperative pain, overall occurrence of complications such as seroma, hematoma, scrotal edema, calf muscle venous thrombosis, and the time of resuming normal activities were compared with patients on whom these medications were not needed.


The age, BMI, hospital stay, ASA classification, morbidity of CHD and hypertension, FIB value, and the time of resuming normal activities of patients taking acetylsalicylic acid were higher (p < 0.05). There was no significant difference on mean operative time, intra-operative bleeding volume, and the occurrence postoperative complications among two groups.


For patients with inguinal hernias, laparoscopic TAPP repair is completely safe to be performed on those taking low-dose acetylsalicylic acid when it was only ceased on the operation day, with intravenous salvianolate given after the operation instead.


Inguinal hernia Anticoagulant Acetylsalicylic acid Laparoscopic repair Complication TAPP 


Compliance with ethical standards

Conflict of interest

None of Zhibo Yan, Yuchen Liu, Rexiati Ruze, Yacheng Xiong, Haifeng Han, Mingwei Zhong, Hanxiang Zhan, Minggang Wang, and Guangyong Zhang has conflicts of interest or financial ties to disclose.

Ethical approval

This clinical trial was approved by the local ethics committee and was registered afterwards (No. ChiCTR-OOC-17011715).

Human and animal rights

The whole procedure was totally conducted in accordance with the Declaration of Helsinki.

Informed consent

Written consents were obtained from all participants.


  1. 1.
    HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia J Hernias Abdom Wall Surg 22:1–165CrossRefGoogle Scholar
  2. 2.
    Piatek B, Piwnik M, Podgorski M, Strzelczyk J (2014) Anticoagulants as a risk factor in patients operated on for abdominal hernia. Polski przeglad chirurgiczny 86:263–267CrossRefGoogle Scholar
  3. 3.
    Kockerling F, Bittner R, Jacob DA, Seidelmann L, Keller T, Adolf D, Kraft B, Kuthe A (2015) TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc 29:3750–3760CrossRefGoogle Scholar
  4. 4.
    Weyhe D, Tabriz N, Sahlmann B, Uslar VN (2017) Risk factors for perioperative complications in inguinal hernia repair—a systematic review. Innov Surg Sci 2(2):47–52Google Scholar
  5. 5.
    Mumme T, Peiper C, Lorenz N, Junge K, Schumpelick V (2000) Does anticoagulation increase the risk of wound hematoma in inguinal hernia surgery? Hernia J Hernias Abdom Wall Surg 4:275–281CrossRefGoogle Scholar
  6. 6.
    Staerkle RF, Hoffmann H, Kockerling F, Adolf D, Bittner R, Kirchhoff P (2018) Does coagulopathy, anticoagulant or antithrombotic therapy matter in incisional hernia repair? Data from the Herniamed Registry. Surg Endosc 32:3881–3889CrossRefGoogle Scholar
  7. 7.
    Kockerling F, Roessing C, Adolf D, Schug-Pass C, Jacob D (2016) Has endoscopic (TEP, TAPP) or open inguinal hernia repair a higher risk of bleeding in patients with coagulopathy or antithrombotic therapy? Data from the Herniamed Registry. Surg Endosc 30:2073–2081CrossRefGoogle Scholar
  8. 8.
    Smoot RL, Oderich GS, Taner CB, Greenlee SM, Larson DR, Cragun EB, Farley DR (2008) Postoperative hematoma following inguinal herniorrhaphy: patient characteristics leading to increased risk. Hernia J Hernias Abdom Wall Surg 12:261–265CrossRefGoogle Scholar
  9. 9.
    Ginelliova A, Farkas D, Farkasova Iannaccone S, Vyhnalkova V (2016) Unexpected fatal outcome of laparoscopic inguinal hernia repair. Forensic Sci Med Pathol 12:178–180CrossRefGoogle Scholar
  10. 10.
    Bombuy E, Mans E, Hugue A, Plensa E, Rodriguez L, Prats M, Sunol X (2009) Elective inguinal hernioplasty in patients on chronic anticoagulation therapy. Management and outcome. Cirugia espanola 86:38–42CrossRefGoogle Scholar
  11. 11.
    Sanders DL, Shahid MK, Ahlijah B, Raitt JE, Kingsnorth AN (2008) Inguinal hernia repair in the anticoagulated patient: a retrospective analysis. Hernia J Hernias Abdom Wall Surg 12:589–592 (discussion 667–588) CrossRefGoogle Scholar
  12. 12.
    Jacobs EJ, Thun MJ, Bain EB, Rodriguez C, Henley SJ, Calle EE (2007) A large cohort study of long-term daily use of adult-strength aspirin and cancer incidence. J Natl Cancer Inst 99:608–615CrossRefGoogle Scholar
  13. 13.
    Ruze R, Yan Z, Wu Q, Zhan H, Zhang G (2019) Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: a prospective randomized controlled study. Surg Endosc 33:1147–1154CrossRefGoogle Scholar
  14. 14.
    Gilbert AI (1989) An anatomic and functional classification for the diagnosis and treatment of inguinal hernia. Am J Surg 157:331–333CrossRefGoogle Scholar
  15. 15.
    Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia J Hernias Abdom Wall Surg 16:261–267CrossRefGoogle Scholar
  16. 16.
    Ajjan RA, Standeven KF, Khanbhai M, Phoenix F, Gersh KC, Weisel JW, Kearney MT, Ariens RA, Grant PJ (2009) Effects of aspirin on clot structure and fibrinolysis using a novel in vitro cellular system. Arterioscler Thromb Vasc Biol 29:712–717CrossRefGoogle Scholar
  17. 17.
    Undas A, Brummel-Ziedins KE, Mann KG (2007) Antithrombotic properties of aspirin and resistance to aspirin: beyond strictly antiplatelet actions. Blood 109:2285–2292CrossRefGoogle Scholar
  18. 18.
    Mackie IJ, Kitchen S, Machin SJ, Lowe GD (2003) Guidelines on fibrinogen assays. Br J Haematol 121:396–404CrossRefGoogle Scholar
  19. 19.
    Zeb MH, Pandian TK, El Khatib MM, Naik ND, Chandra A, Morris DS, Smoot RL, Farley DR (2016) Risk factors for postoperative hematoma after inguinal hernia repair: an update. J Surg Res 205:33–37CrossRefGoogle Scholar
  20. 20.
    Canonico S, Sciaudone G, Pacifico F, Santoriello A (1999) Inguinal hernia repair in patients with coagulation problems: prevention of postoperative bleeding with human fibrin glue. Surgery 125:315–317CrossRefGoogle Scholar
  21. 21.
    Zhang FR, Zheng Y, Yan LJ, Ma CS, Chen JT, Li W (2018) Cryotherapy relieves pain and edema after inguinal hernioplasty in males with end-stage renal disease: a prospective randomized study. J Pain Symptom Manag 56:501–508CrossRefGoogle Scholar
  22. 22.
    Humes DJ, Abdul-Sultan A, Walker AJ, Ludvigsson JF, West J (2018) Duration and magnitude of postoperative risk of venous thromboembolism after planned inguinal hernia repair in men: a population-based cohort study. Hernia J Hernias Abdom Wall Surg 22:447–453CrossRefGoogle Scholar
  23. 23.
    Yang C, Zhu L (2017) Sudden death caused by acute pulmonary embolism after laparoscopic total extraperitoneal inguinal hernia repair: a case report and literature review. Hernia J Hernias Abdom Wall Surg 21:481–486CrossRefGoogle Scholar
  24. 24.
    Gerstein NS, Schulman PM, Gerstein WH, Petersen TR, Tawil I (2012) Should more patients continue aspirin therapy perioperatively?: clinical impact of aspirin withdrawal syndrome. Ann Surg 255:811–819CrossRefGoogle Scholar
  25. 25.
    Alcock RF, Reddel CJ, Pennings GJ, Hillis GS, Curnow JL, Brieger DB (2014) The rebound phenomenon after aspirin cessation: the biochemical evidence. Int J Cardiol 174:376–378CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General Surgery, Qilu HospitalShandong UniversityJinanPeople’s Republic of China
  2. 2.Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang HospitalCapital Medical UniversityBeijingPeople’s Republic of China

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