Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep;16(3):552-559.
doi: 10.5114/wiitm.2021.103953. Epub 2021 Feb 26.

Totally extraperitoneal inguinal hernia repair in patients with hemophilia and von Willebrand disease. Prospective controlled study

Konrad Pielaciński  1 , Bartosz Puła  2 , Andrzej B Szczepanik  1
Affiliations

Totally extraperitoneal inguinal hernia repair in patients with hemophilia and von Willebrand disease. Prospective controlled study

Konrad Pielaciński et al. Wideochir Inne Tech Maloinwazyjne. 2021 Sep.

Abstract

Introduction: Laparoscopic surgery is associated with several advantages. Surgical procedures in hemophilia or von Willebrand patients without replacement therapy (RT) to correct clotting factor deficiency may result in serious, life-threatening hemorrhagic episodes. Clotting factor concentrates improve hemostatic control but bleeding risk in major invasive procedures remains high.

Aim: Evaluation of totally extraperitoneal inguinal hernia repair (TEP-IHR) in patients with congenital hemorrhagic disorders (H) and comparison with results for non-hemophiliacs (NH) with regard to bleeding, postoperative pain, hernia recurrence, surgery time, demand for painkillers, hospital stay and recovery time.

Material and methods: The prospective controlled trial included 67 consecutive male patients scheduled for TEP-IHR between January 2010 and December 2018. Surgery was performed in groups H (n = 22) and NH (n = 45). Full study inclusion criteria were met by 65 patients (22 and 43 in H and NH groups respectively). Follow-up was carried out on the 1st, 2nd, and 7th day and in the 1st and 3rd month postoperatively.

Results: TEP-IHR was successful for all patients. No life-threatening bleeding occurred and no patient required red blood cell transfusions or reoperation. No hernia recurrence was reported. No statistically significant differences were observed between the groups with regard to surgery duration, postoperative hematoma frequency and demand for painkillers. In the H group, pain intensity was significantly higher during the first postoperative month and hospitalization and recovery were significantly longer.

Conclusions: TEP-IHR in hemophiliacs with RT is feasible and as effective for preventing hernia recurrence as in NH-patients. In hemophiliacs risk of bleeding complications and demand for painkillers are comparable to non-hemophiliacs although pain is more intense.

Keywords: bleeding diathesis; hemophilia; hemorrhagic complications; hernia recurrence; totally extraperitoneal inguinal hernia repair.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart
Figure 2
Figure 2
Median clotting factor levels, median IU/dl and range
Figure 3
Figure 3
Pain intensity in postoperative period (NRS) median and range
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. HerniaSurge Group International guidelines for groin hernia management. Hernia. 2018;22:1–165. - PMC - PubMed
    1. Mitura K, Śmietański M, Kozieł S, et al. Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients. Hernia. 2018;22:585–91. - PMC - PubMed
    1. Atkinson TM, Giraud GD, Togioka BM, et al. Cardiovascular and ventilatory consequences of laparoscopic surgery. Circulation. 2017;135:700–10. - PubMed
    1. Zychowicz A, Radkowiak D, Lasek A, et al. Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count. Videosurgery Miniinv. 2018;13:157–63. - PMC - PubMed
    1. Lingohr P, Bensoukehal S, Matthaei H, et al. Value and risk of laparoscopic surgery in hemophiliacs-experiences from a tertiary referral center for hemorrhagic diatheses. Langenbecks Arch Surg. 2014;399:609–18. - PubMed