The Advantages of Laparoscopy Compared With Open Inguinal - Copy

8/10/2019 The Advantages of Laparoscopy Compared With Open Inguinal - Copy

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THE ADVANTAGES OF

LAPAROSCOPYCOMPARED WITH

OPEN INGUINAL

VARICOCELECTOMY

Florin Iulian DUMITRACHE , Dan Teodor POTECA ,Daniela

Elena MIHAILA

Carol Davila University of Medicine and Pharmacy , Bucharest

,Romania

Clinical Hospital Colentina, Department of General Surgery Clinic II

7th IMSCS ASKLEPIOS 2014


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Varicocele is the varicose dilatation of

the pampiniform venous plexus and is

generally considered the most common

correctable cause of male infertility



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The ideal procedure should perform a varicocelectomy

with a low rate of recurrence, hydrocele formation, andtesticular atrophy .

The indication for varicocelectomy includes testicular

volume discrepancy, chronic scrotal

pain and infertility without other apparent causes


Laparoscopic varicocelectomy has gained popularity in

recent years in detriment of traditional open surgery due

to its minimally invasive nature , low morbidity, pain andrecovery time


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The aim of this work is to compare the postsurgical

outcome of laparoscopic and open subinguinal

varicocelectomy ,with regard to length of recovery ,

postoperative pain ,hydrocele recurrence and cost-effectiveness

This clinical study enrolled 24 patients ,age 33-48

(median ~39 ) who underwent either open inguinal or

laparoscopic varicocelectomy in Clinical Hospital

Colentina, Department of General Surgery Clinic II,

Bucharest, between august 2013 and march 2014


In addition, in the laparoscopic group were 9 casesvaricocelectomy associated with abdominalherniarepaired under the same anesthesia.


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By type of surgery, we divided the patients into 2 groups :

Group A ->laparoscopy

Group B ->open inguinal


54%46%

Varicocelectomy

Group A

Group B


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OPERATIVE TECHNIQUE

Open inguinal approach (Ivanissevich)

Incision is made one finger breadth above medial part

of inguinal ligament .The skin,fascia of external obliqueare cut.The cord is mobilized .Spermatic fascia is incised

and dilated veins are identified .Vas deference arteries

and two or three veins are separated and excised

between ligatures.The wound is closed in layers.

Laparoscopic (Palomo)

A three-puncture technique is used with carbon dioxide

insufflation. The spermatic vessels are individually identified

and clips are used to ligate the veins. The spermatic artery is

preserved in all cases.


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1.1 Varicocelectomy -testicular vein denudation

1.2 Spigelian hernia -fixing the

surgical mesh


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The operations were successful in all the cases.

Analgesic requirements were determined by the

number of tablets recorded by the patient in the

postoperative period.

Data was recorded on a standardized data collection


The postsurgical outcome was assessed byphysical examination of the scrotum for any

complications like persistence , hydrocele,

hematoma, recurrence , wound infection and

testicular atrophy in the follow up period


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DATA

Nr pacient Age Varicocelectomy Mean hospital stay Hydrocele Associated surgery Analgesic requirement(1-10 )

1 35 laparoscopic 2 no yes 2

2 38 open 7 no no 7

3 40 laparoscopic 2 yes yes 1

4 48 laparoscopic 3 no no 3


6 34 open 4 no no 8




10 33 open 5 no no 7


12 46 open 6 yes no 6

13 38 open 5 no no 10












MEAN AGE 39.29


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RESULTS


0

2

4

6

8

10

12

14

16

18

20

laparoscopic open inguinal

7.69

18.18

Hyd r oc e l e r ecu r r en ce (%)

In this series, three patient in the open inguinal group and onein laparoscopic group developed hydrocele. This finding is inagreement with other studies which suggest that thelaparoscopic approach has less incidence of hydocele because

of better visualization of cord structures


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RESULTS


The mean operative time of inguinal varicocelectomy was

significantly less than that of laparoscopic

varicocelectomy .

[VALUE]min

[VALUE]min

LAPAROSCOPIC

OPEN INGUINAL

Mean operative time


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RESULTS

However, the mean length of the postoperativehospital stay was significantly less in thelaparoscopic group.

Laparoscopic

Open inguinal

2.33

4.83

MEAN HOSPITAL STAY (DAYS)


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RESULTS


0 2 4 6 8 10 12 14 16

LAPAROSCOPIC

OPEN INGUINAL

Mean analgesic requirement(tablets )

The postoperative, analgesic requirement was

significantly less in the laparoscopic group than

the open inguinal group


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RESULTS


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CONCLUSIONS

The laparoscopic approach is obviously superior to

open surgery for its advantages of minimal

invasiveness, fast recovery and less analgesic

requirement.

Also, it allows the surgeon to treat simultaneouslybilateral varicocele and abdominal hernia under the

same


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7th IMSCS ASKLEPIOS 20147th IMSCS ASKLEPIOS 2014

CONCLUSIONS

Furthermore, laparoscopic surgery requires more

extensive resources and general anaesthesia.

We recommend open inguinal operation as aneffective procedure where availability and costs

of laparoscopic instruments are barriers

The open inguinal operation had the advantage of a

low cost , whereas laparoscopic varicocelectomyhad the advantage of less analgesic requirement and

a shorter hospital stay.

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The Advantages of Laparoscopy Compared With Open Inguinal - Copy