COUMARIN VERSUS TRYPSIN–CHYMOTRYPSIN FOR POSTOPERATIVE SPERMATIC CORD EDEMA FOLLOWING INGUINAL HERNIA REPAIR: A RETROSPECTIVE COMPARATIVE COHORT STUDY

Abstract

Introduction: Spermatic cord edema post inguinal hernia repair is a condition that leads to discomfort, testicular viability concern, and functional impairment. Pharmacotherapy can help in resolving this complication. We aimed to compare coumarin versus trypsin-chymotrypsin in treatment of this complication. Methods: The present study was conducted as retrospective comparative study on 60 patients who suffered from postoperative spermatic cord edema after elective inguinal hernioplasty, 30 patients were treated with coumarin 200 mg b.i.d. and 30 patients with trypsin-chymotrypsin t.i.d. for 7 days. Postoperative spermatic cord edema grading during the days 1, 3, 7, 14, and 30 were the primary outcome measures. Other outcomes included pain scores (using Visual Analog Scale), resolution duration, need for analgesics, ability to resume daily activities, postoperative complications and side effects of drugs. Results: Baseline characteristics were similar in both groups. Edema scores on postoperative days 7 and 14 were significantly lower in the coumarin group (POD 7: 0.88±0.41 vs 1.48±0.50, p<0.001; POD 14: 0.16±0.37 vs 0.68±0.43, p<0.001). Edema resolution took shorter time with coumarin (7.9±1.7 vs 10.2±2.0 days, p<0.001). Pain scores were lower and return to daily activities occurred earlier in the coumarin group. Both groups showed good tolerability with low frequency of adverse events and stable levels of liver function tests throughout the 7 days of the study. The incidence of complications (hematoma, seroma, infection) was comparable. Limitations: This non-randomized, unblinded, single-center, retrospective study is vulnerable to the problems of indication bias (selection of treatment by the surgeon) and observer bias (evaluation of subjective outcomes by the surgeon). The 30 day observation period may not identify latent liver toxicity. Sonography-based objective measure was not used. Small number of patients makes detection of rare side effects difficult. Conclusion: Within the limitations of this retrospective design, coumarin demonstrated faster elimination of postoperative spermatic cord edema compared with trypsin-chymotrypsin. However, taking into account biases present in this retrospective design, such associations must not be interpreted as causal relationships. Randomized prospective trials with blinded allocation of interventions, objective evaluation of outcomes, long-term follow-up (3 6 months) and larger patient numbers are needed to establish clinical recommendations. Other edematogenic agents with good safety profiles are preferred at the moment.  Keywords: spermatic cord edema, coumarin, trypsin chymotrypsin, inguinal hernia repair, postoperative complications, pharmacological management