Publication: Adölesan varikosel tedavisinde uygulanan üç farklı cerrahi yöntem sonuçlarının karşılaştırılması
Abstract
AMAÇ: Adölesan dönem varikosel tedavisinde henüz fikir birliğine ulaşılmış ve ideal teknik tanımlanmış değildir. Açık cerrahi (mikroskopiyardımlı veya değil) veya laparoskopik teknikler tedavide kullanılan cerrahi yöntemlerdir. Bu çalışmada laparaskopik, mikroskopik, ve açık varikoselektomi tekniklerinin sonuçlarının karşılaştırılması planlanmıştır.GEREÇ ve YÖNTEM: 2003–2018 yılları arasında varikosel tedavisi yapılmış olan adölesan ve preadölesan hastalar geriye dönük olarak üç ayrıgrupta değerlendirildi. Laparoskopik varikosel ligasyonu (LVL) yapılanhastalar grup 1’e, mikroskopik varikoselektomi (MV) yapılan hastalargrup 2’ye, subinguinal makroskopik varikoselektomi (SV) yapılan hastalar grup 3’e alındı. Operasyona ait ve operasyon sonrası takip dönemiverileri açısından üç grup birbiri ile karşılaştırıldı.BULGULAR: Grup 1’de 30 hasta, grup 2’de 43 hasta, grup 3’de 40 hastaolmak üzere toplam 113 hastanın verisi retrospektif olarak analiz edildi.Tüm çalışma grubunun yaş ortalaması 13,2 yıl idi. Gruplar arasında taraf ve varikosel derecesi açısından anlamlı fark yoktu. Ortanca operasyonsüresi grup 1, 2 ve 3’de sırasıyla 55 (35–70), 50 (40–80) ve 55 dakika(40–70) olarak saptandı (p>0,05). Operasyon sonrasında hidrosel gelişimi, gruplarda sırasıyla toplam 3, 1 ve 2 hastada saptandı (p>0,05).Varikosel nüksü LVL grubunda görülmezken MV grubunda 3 hastada,SV grubunda ise 7 hastada görüldü (p>0,05). Postoperatif testis volümkaybı Grup 1’de 3 hastada, Grup 2’de 1 hastada görülürken Grup 3’dehiçbir hastada görülmedi. Gruplar arasında sonuçlar veya komplikasyonlar açısından klinik farklılıklar olmasına rağmen yaş ve operasyonesnasında bağlanan damar sayısı haricinde istatistiksel anlamlı bir farkbulunmadı.SONUÇ: Adölesan varikosel tedavisinde her üç tekniğin de başarı ile uygulanabileceği ancak mikroskobik veya lup ile büyütme altında yapılanvarikoselektomi tekniğinde komplikasyon görülme oranının daha az,klinik başarı ihtimalinin ise daha yüksek olduğu görülmüştür.
OBJECTIVES: In the treatment of adolescent varicocele, there isn’t any consensus and the ideal technique is not yet defined. Open surgery (microscopy-assisted or not) or laparoscopic techniques are surgical methods used in treatment. We planned to compare the results of microscopic, laparoscopic and open varicocelectomy techniques. MATERIAL and METHODS: Patients who underwent varicocele therapy between 2003–2018 were evaluated retrospectively in 3 groups. Patients who underwent laparoscopic varicocele ligation were included in Group 1, patients who underwent microscopic varicocelectomy were included in Group 2 and patients who underwent subinguinal varicocelectomy were included in Group 3. Three groups were compared in terms for operation and postoperative follow-up data. RESULTS: The study included 113 patients, 30 patients in Group 1, 43 patients in Group 2, 40 patients in Group 3. The mean age was 13.2 years. There was no significant difference between groups in terms of side and varicocele degree. The median operation times for group1.2 and 3 were 55 (35–70), 50 (40–80) and 55 min. (40–70) (p>0.05). The hydrocele development after surgery was detected in 3, 1 and 2 patients, respectively (p>0.05). Varicocele recurrence was not seen in the LVL group, but it was seen in 3 patients in the MV group and in 7 patients in the SV group (p>0.05). Postoperative testicular volume loss was detected in 3 patients in Group 1, 1 patient in Group 2 and in Group 3 no patient was detected. There was no statistical significant different between groups although there were clinical differences between the groups in terms of results or complications. CONCLUSION: In the treatment of adolescent varicoceles, it was found that all 3 techniques can be used successfully but in microscopic or under magnification (via loop) techniques, complication rates seem to be much less and clinical successful rates seem to be much higher.
OBJECTIVES: In the treatment of adolescent varicocele, there isn’t any consensus and the ideal technique is not yet defined. Open surgery (microscopy-assisted or not) or laparoscopic techniques are surgical methods used in treatment. We planned to compare the results of microscopic, laparoscopic and open varicocelectomy techniques. MATERIAL and METHODS: Patients who underwent varicocele therapy between 2003–2018 were evaluated retrospectively in 3 groups. Patients who underwent laparoscopic varicocele ligation were included in Group 1, patients who underwent microscopic varicocelectomy were included in Group 2 and patients who underwent subinguinal varicocelectomy were included in Group 3. Three groups were compared in terms for operation and postoperative follow-up data. RESULTS: The study included 113 patients, 30 patients in Group 1, 43 patients in Group 2, 40 patients in Group 3. The mean age was 13.2 years. There was no significant difference between groups in terms of side and varicocele degree. The median operation times for group1.2 and 3 were 55 (35–70), 50 (40–80) and 55 min. (40–70) (p>0.05). The hydrocele development after surgery was detected in 3, 1 and 2 patients, respectively (p>0.05). Varicocele recurrence was not seen in the LVL group, but it was seen in 3 patients in the MV group and in 7 patients in the SV group (p>0.05). Postoperative testicular volume loss was detected in 3 patients in Group 1, 1 patient in Group 2 and in Group 3 no patient was detected. There was no statistical significant different between groups although there were clinical differences between the groups in terms of results or complications. CONCLUSION: In the treatment of adolescent varicoceles, it was found that all 3 techniques can be used successfully but in microscopic or under magnification (via loop) techniques, complication rates seem to be much less and clinical successful rates seem to be much higher.