| Abstract | Cilj istraživanja: Cilj ove studije je ispitati čimbenike ishoda liječenja u adolescenata
operiranih zbog simptomatske varikocele laparoskopskim pristup primjenom harmoničnog
rezača u odnosu na adolescente koji su operirani primjenom polimerskog klipa.
Ispitanici i metode: U studiju je uključeno 270 adolescenata s medijanom dobi od 16 (raspon
13–17) godina. S obzirom na korištenu tehniku laparoskopske varikocelektomije bolesnici su
podijeljeni u dvije skupine. U prvoj skupini (n=151) za resekciju spermatičnih krvnih žila
korišten je polimerski klip, dok je u drugoj skupini (n=119) korišten harmonični rezač. Primarna
mjera ishoda bila je učinak primijenjene laparoskopske tehnike na ishode liječenja
(poslijeoperacijske komplikacije i nastanak recidiva). Sekundarne mjere ishoda bile su duljina
trajanja operacijskog zahvata i anestezije te i duljina hospitalizacije.
Rezultati: Trajanje kirurškog zahvata (12 min (IQR 11, 15) u odnosu na 15 min (12, 19)
P=0,029) i anestezije (21,5 min (16, 29,5) u odnosu na 28 min (23, 34) P=0,003) bilo je kraće
u skupini adolescenata u kojih je laparoskopska varikocelektomija učinjena harmoničnim
rezačem u odnosu na one u kojih je korišten polimerski klip. Nije pronađena statistički značajna
razlika, između ispitivanih skupina, s obzirom na duljinu hospitalizacije, stopu recidiva
(P>0,999) i komplikacija (P=0,703). Nije bilo slučajeva testikularne atrofije u obje skupine.
Nešto viša incidencija pojavnosti hidrocele zabilježena je u skupini bolesnika u kojih je
laparoskopska varikocelektomija učinjena harmoničnim rezačem (n=4, 3,4%) u odnosu na one
u kojih je korišten polimerski klip (n=2, 1,3 %) (P=0,410). Na ponovnom pregledu šest mjeseci
nakon zahvata utvrđeno je da većina bolesnika nakon laparoskopske varikocelektomije
pokazala umjereno ili značajno poboljšanje u spermiogramu (n=85, 89,5%), subjektivne tegobe
ili bol nestale su u većine bolesnika (n=71, 93,4%), Testikularni volumen testisa značajno se
povećao u 132 adolescenta (89,8%).
Zaključak: Laparoskopska varikocelektomija primjenom harmoničnog rezača ili polimerskog
klipa sigurna je i učinkovita metoda liječenja simptomatske varikocele u adolescenata.
Čimbenici ishoda liječenja nakon laparoskopske varikocelektomije podjednaki su bez obzira
jeli za resekciju krvnih žila korišten polimerski klip ili ultrazvučni rezač. Primjenom
harmoničnog rezača za resekciju spermatičnih krvnih žila skraćuje se ukupno vrijeme trajanja
operacijskog zahvata i anestezije. |
| Abstract (english) | Background: The aim of this study is to investigate treatment outcomes in adolescents who
underwent laparoscopic surgery with a harmonic scalpel for symptomatic varicocele compared
with adolescents who underwent surgery with a polymer clip.
Methods: A total of 270 adolescents with a median age of 16 (interquartile range, IQR 13–17)
years were included in the study. Taking into account the laparoscopic varicocelectomy
technique used, the patients were divided into two groups. In the first group (n=151) a polymer
clip was used, while in the second group (n=119) a harmonic scalpel was used to resect the
spermatic vessels. The primary outcome measure was the effect of the laparoscopic technique
used on treatment outcomes (postoperative complications and recurrence rates). Secondary
outcomes were the duration of surgery and anesthesia and the length of hospital stay.
Results: The duration of the surgical procedure (12 min (IQR 11, 15) versus 15 min (12, 19)
P=0.029) and anesthesia (21.5 min (16, 29.5) vesrus 28 min (23, 34) P=0.003) was shorter in
the group of adolescents in whom laparoscopic varicocelectomy was performed with a
harmonic scalpel than in the group in which a polymer clip was used. No statistically significant
difference was found between the groups studied in terms of length of hospital stay, recurrence
rate (P>0.999) and complications (P=0.703). There were no cases of testicular atrophy in either
group. In the group of patients who underwent laparoscopic varicocelectomy with a harmonic
scalpel, a slightly higher incidence of hydroceles was found (n=4, 3.4%) than in the group in
which a polymer clip was used (n=2, 1.3%) (P=0.410). At six-month follow-up, it was found
that the majority of patients showed moderate or significant improvement in spermiogram after
laparoscopic varicocelectomy (n=85, 89.5%). In addition, the subjective discomfort or pain
disappeared in the majority of patients (n=71, 93.4 %). The testicular volume increased
significantly in 132 adolescents (89.8 %).
Conclusion: Laparoscopic varicocelectomy with polymer clip or ultrasonic scalpel is safe and
effective in adolescents with symptomatic varicocele. Treatment outcomes after laparoscopic
varicocelectomy are the same regardless of whether a polymer clip or an ultrasonic scalpel is
used to resect the spermatic vessels. The use of an ultrasonic scalpel for resection of the
spermatic vessels shortens the overall duration of surgery and anesthesia. |
