# Safety of Laparoscopic Hernia Surgery in Patients With Preoperative Antiplatelet Continuation Therapy

## TL;DR

This study shows laparoscopic hernia surgery can be safely performed in patients continuing aspirin therapy, with no significant increase in bleeding risks.

## Contribution

Demonstrates the safety of continuing aspirin therapy preoperatively in laparoscopic hernia surgery patients.

## Key findings

- Continuation of preoperative aspirin was not a risk factor for postoperative bleeding complications.
- Heparin or DOAC replacement was significantly associated with increased bleeding risk.
- No thromboembolic complications occurred in the studied cohort.

## Abstract

Introduction

The optimal perioperative antithrombotic management of patients receiving antithrombotic therapy (ATT) remains controversial. In this study, we investigated the safety and feasibility of laparoscopic hernia surgery in patients taking ATT, especially those with a preoperative continuation of single antiplatelet therapy (APT).

Methods

Three hundred ninety-six (396) patients who underwent laparoscopic hernia surgery between April 2014 and March 2023 in our institution were retrospectively reviewed. The patients were divided into two groups: patients who continued single aspirin monotherapy preoperatively (continued single aspirin therapy (cAPT) group; n = 118) and patients who did not receive APT preoperatively (non-APT group; n = 278). Our perioperative antithrombotic management included preoperative continuation of single aspirin therapy for patients with APT or interruption of oral anticoagulation therapy (ACT), bridging anticoagulation with unfractionated heparin or direct-acting oral anticoagulants (DOAC) replacement for patients with ACT. The primary outcome was postoperative bleeding complications (BC).

Results

There were four postoperative BCs (Clavien-Dindo classification ≧ Ⅱ) (1.0%) in the whole cohort, one (0.9%) in the cAPT group, and three (1.1%) in the non-APT group, which were not significantly differentiated (p = 0.8330). Multivariable analysis showed heparin or DOAC replacement was an independently and significantly risk factor for postoperative bleeding (p = 0.0029, odds ratio (OR) = 32.6). Continuation of preoperative aspirin was not a risk factor for postoperative BCs. No thromboembolic complications occurred in the whole cohort.

Conclusion

We can safely and feasibly perform laparoscopic hernia surgery under preoperative antithrombotic management, including the preoperative continuation of single aspirin therapy, without any increase in bleeding events. However, careful consideration is required for the patient who received heparin bridging or DOAC replacement.