Page 26 - Journal of Laparoscopic Surgery

Shaukat Jeelani et al.
Intraoperative Complications The fear of disfiguring scar, prolonged hospital stay,
the double incision for bilateral varicocele and associated
In both the groups, no vascular or intestinal complications
occurred. Conversion from laparoscopic to open approach prolonged postoperative pain and the longer duration to
due to hemorrhage or other causes did not occur either. return to normal activity had been the major concern of
most of the patients undergoing open varicocelectomy.
Postoperative Complications In our series of 100 patients the minimum age was 10
and maximum was 50 years (Table 1) in a comparative
Six patients in laparoscopic and eleven patients in open study conducted by Bebars et al. the age of patients in
surgery suffered from persistent pain, one in group A laparoscopic group was 8–39 years (mean 21.3) and it was
and one patient in group B developed scrotal edema, 8–42 years (mean 24.4) in open varicocelectomy group.
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five patients in group B and three in group A developed Lynch WJ et al. reported the age range of patients in open
hydrocele which was treated by rest, nonsteroidal anti- group 25–48 years and in the laparoscopic group it was
inflammatory drugs, and scrotal supports. Recurrence 23–49 years. Age group of 16–54 years was reported by
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was more in group B, and the patients underwent open Hagood. 9
Varicocelectomy under GA. No hernias occurred after In our study of 100 varicoceles patients, 86 had scrotal
laparoscopic varicocelectomy. In group A, there were pain, and eighty one had testicular swelling and 25
6 patients with wound infection, all of which were patients presented with infertility (Graph 1 and Table 2)
managed by medical therapy (Graph 3). similar observations were made by Al-Shareef et al.
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and reported that in 26 varicoceles who were treated by
DISCUSSION laparoscopic ligation of internal spermatic veins under
There are different surgical methods for varicocele general anesthesia. Twenty-one patients had either
treatment. The first surgical method for varicocele was scrotal discomfort or painful swelling and four patients
explained by Celsus in the first century (ipsilateral orchi- presented with infertility.
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dectomy which consisted of an atrophic testis). The The operation time was calculated from trocar inser-
technique of laparoscopic varicocelectomy has gained tion to trocar extraction and skin closure for laparoscopic
wide acceptance since its introduction by Winfield and varicocelectomy 48 minutes (mean) and in open surgery
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his colleagues in 1991. Reports have suggested that lapa- was 57 minutes (mean) (Graph 2 and Table 3). The average
roscopic approach not only carried lesser morbidity, less operating time for laparoscopic varicocelectomy after the
postoperative pain, early return to routine work but also training period has been completed was 44 minutes in
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had the same success rate as open procedures. series by Garridoa et al. In a study by Matsuda et al., the
The most effective and least invasive method is yet operating time for laparoscopic varicocelectomy reported
unknown. We compared open varicocelectomy under was 35–135 minutes (mean 85 minutes). 12
GA with the laparoscopic approach. We found that In our study instead of demand analgesic, we gave
although the two methods had comparable results, every patient in both the groups, injection diclofenac
regarding and complications and laparoscopic method sodium on 12 hourly bases to make patients pain free
was not superior. on the day of surgery. However, from the 1st postope-
rative day, it was given on demand. We observed that

Table 1: Age distribution of patients in our study
Age in Group A Group B
years No. Percentage (%) No. Percentage (%)
10–19 10 20 12 24
20–29 27 54 22 44
30–39 11 22 9 18
40–49 2 4 7 14
Total 50 100 50 100

Table 2: Presentation in both groups
Group A Group B
Presentation No. Percentage (%) No. Percentage (%)
Scrotal pain 15 30 13 26
Testicular 26 52 25 50
swelling
Graph 3: Varicocelectomy complications with
different surgical methods Infertilitty 9 18 12 24
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