Is the Perioperative Continuation of Antiplatelet Therapy Safe for Elective Hernia Surgery?

Antiplatelet medication use in the perioperative period for elective surgical procedures remains controversial. We hypothesized that for elective hernioplasty, the continuation of antiplatelet agents would not increase postoperative complications. A single surgeon prospectively tracked all elective hernia repairs performed. All patients were included except those on anticoagulation therapy. Patients already on antiplatelet therapy (APT) continued their regimen throughout the perioperative period, whereas those who were not remained off antiplatelet medications. All patients had postoperative visits between 7 and 10 days at which point they were evaluated with complications documented. One thousand four patients underwent open hernia repair. Two hundred sixty-seven patients were taking APT, whereas 737 were not. The mean age of the antiplatelet group was greater than those not on APT (66 vs 51 years old, P < 0.0001). Ecchymosis occurred more frequently in the APT group than in those not on APT (9.36% vs 2.71%, P = 0.0005). This was the only statistically significant difference in postoperative complications noted between these two groups. Patients taking clopidogrel alone or a combination of aspirin and clopidogrel had a significantly higher rate of ecchymosis compared with those on other antiplatelet regiments (10%, 21.6%, and 7.4%, respectively, P = 0.047). There were no postoperative hematomas, bleeding complications, urinary retention, or any patients who required cessation of antiplatelet medications. Continuation of APT in the perioperative period for elective hernia repair did not result in an increased frequency of postoperative complications except for ecchymosis development. We conclude that the continuation of antiplatelet medications throughout the perioperative period of elective hernioplasty is safe.

A new subtype of Hodgkin's lymphoma, syncytial nodular sclerosing: first case report of primary small bowel lymphoma.

INTRODUCTION: Gastrointestinal lymphomas may arise as a component of systemic disease with GI involvement or primary neoplasm. The diagnosis of primary GI lymphoma requires the lack of peripheral or mediastinal lymphadenopathy, normal white blood cell count, and differential on the peripheral blood smear; tumor involvement must be predominantly in the GI tract, and no evidence of liver or spleen involvement. The small bowel accounts for approximately 9% of the GI lymphomas. CASE REPORT: We describe a first case of primary small bowel Hodgkin's lymphoma syncytial variant nodular sclerosing type. A 28-year-old man with history of long-term use of immuno-suppressive agent and steroid presents with partial obstructing abdominal-mass-causing anemia and lower gastrointestinal bleeding. The patient underwent colonoscopy because of progressive microcytic anemia. Colonoscopy revealed non-specific polyps that were non-bleeding. The patient continued to have symptoms of abdominal cramping and twitching sensation that led to serial of small bowel radiology studies which showed multiple filling defects and a partial small bowel obstruction. The patient underwent small bowel resection, which showed Hodgkin's lymphoma syncytial variant type of nodular sclerosing. CONCLUSION: This presentation is uncommon and, so far, there are less than ten cases reported with syncytial variant (SV) type of nodular sclerosing Hodgkin's lymphoma (NSHD). All of which have presentation above the diaphragm and, to our knowledge, this represents the first case that primary SV type of NSHD originated from the small intestine.