RANDOMIZED CONTROLLED TRIAL (RCT) ON PREOPERATIVE CESSATION VS NO PREOPERATIVE CESSATION OF ASPIRIN IN LAPAROSCOPIC INGUINAL HERNIA REPAIR

Abstract Background The incidence of inguinal hernia is increasing in view of the ageing population worldwide. Cardiovascular and cerebrovascular co-morbidities are the commonest indications for use of anti-thrombotic agents (including aspirin) in this age group. This highlights the need to understand risk of adverse thromboembolic events like acute myocardial infarction and strokes (when ceasing aspirin) versus risk of bleeding (when not ceasing aspirin) in patients undergoing laparoscopic inguinal hernia repair. Method A prospective RCT was designed to recruit 100 patients with either unilateral or bilateral reducible inguinal hernia undergoing laparoscopic inguinal hernia repair in a tertiary hospital. Exclusion criteria include patients who are unfit for general anaesthesia, had obstructed or strangulated hernias. Primary outcome was post-operative bleeds while secondary outcomes included post-operative thromboembolic events, surgical-site infections, and duration of hospitalisation. Results Our interim results reveals 65 patients recruited since 2015. 30 have been randomised to continue aspirin preoperatively (46.2%) while 35 have been randomised to stop aspirin 5 days preoperatively (53.8%). Most patients were male, had similar mean BMI (23.6 vs. 24.0), American Society of Anaesthesiologists (ASA) grading, had primary bilateral hernias and comparable mean defect size. There was no statistically significant difference in all post-operative complications. Mean follow up duration was 190.9 days. Conclusion Aspirin vs. no aspirin cessation preoperatively had no statistically significant difference between post-operative bleeding or thromboembolic events. This study challenges the practice that aspirin needs to be withheld before an elective laparoscopic inguinal hernia repair.