| Abstract | Cilj istraživanja: Cilj ovog istraživanja je odrediti epidemiološke, demografske i kliničke karakteristike u djece operirane zbog varikocele laparoskopskim i otvorenim pristupom te analizirati i usporediti ishode liječenja, stopu komplikacija i spermiogram u odnosu na stadij varikocele nakon operacije.
Ispitanici i metode: Od siječnja 2012. do siječnja 2018. godine u studiju je ukupno uključeno 537 ispitanika. Obzirom na operacijski pristup ispitanici su podijeljeni u dvije skupine. Prvu skupinu činilo je 142 ispitanika koji su operirani laparoskopskim pristupom, a drugu 395 ispitanika u kojih je učinjena otvorena varikocelektomija. Skupine su uspoređene s obzirom na demografske i kliničke podatke, indikacije za operacijsko liječenje te ishode liječenja.
Rezultati: Srednja dob u vrijeme operacijskog zahvatau obje skupine iznosila je 15 godina. Od ukupnog broja operirane djece, njih 533 (99.25%) imalo je varikocelu s lijeve strane. Četvero djece (0.75%) imalo je obostranu varikocelu. Od 537 varikocela, 42 (7.8%) ih je bilo klasificirano u stadij I, 227 (42.3%) u stadij II i 268 (49.9%) u stadij III. Medijan promjera vena varikocela stadija I, II i III iznosio je 2.9 mm, 3.1 mm i 4.0 mm. Najčešća indikacija za operacijski zahvat u obje skupine bila je hipotrofija testisa (53.4%). Slijede je subjektivne tegobe u smislu boli ili nelagode (25.7%), patološki spermiogram (23.8%) i poremećaj hormonskog statusa LH/FSH (10.4%). Medijan duljine boravka u bolnici iznosio je 1 dan kod laparoskopskog i 1.3 dana kod otvorenog pristupa (p=0.0041). Medijan operacijskog vremena kod laparoskopskog pristupa iznosio je 12 min, dok je u otvorenog iznosio 25 min (p˂0.00001). Ukupno je zabilježeno 35 poslijeoperacijskih komplikacija, i to u tri (2.1%) ispitanika operirana laparoskopskim pristupom i 32 (8.1%) kod otvorenog pristupa (p=0.013). Najčešća kompikacija bila je formiranje konsekutivne hidrocele (n=29, 83%), i to u dvoje (1.4%) ispitanika operiranih laparoskopskim pristupom i u njih 27 (6.8%) operiranih otvorenim pristupom (p=0.014). Ukupno je zabilježeno 16 recidiva. Svi recidivi zabilježeni su u skupini ispitanika operiranih otvorenim pristupom (p=0.049). U obje skupine ispitanika koncentracija spermija (p<0.01), morfologija (p<0.01) i motilitet (laparoskopija, p=0.02; p<0.01; otvorena varikocelektomija, p<0.01; p=0.04) poboljšali su se šest mjeseci nakon operacije u pacijenata s varikocelom stadija I i II. U stadiju III varikocele zabilježeno je poboljšanje u koncentraciji spermija (p<0.01) i morfologiji (p=0.03; p=0.06), dok se motilitet spermija (p=0.150; p=0.240) nije značajno oporavio u obje skupine. Do značajnog poboljšanja u volumenu testisa došlo je u 75% ispitanika operiranih laparoskopskim pristupom i 76.8% opeiranih otvorenim pristupom. U 82.2% ispitanika operiranih laparoskopskim i 79.6% ispitanika operiranih otvorenim pristupom zbog subjektvnih tegoba iste su se povukle nakon operacijskog zahvata.
Zaključci: Laparoskopska i otvorena varikocelektomija jednako su učinkovite i dovode do statistički značajnog poboljšanja volumena testisa, nestanka subjektivnih tegoba, kao i poboljšanja spermiograma u adolescenata. Laparoskopska varikocelektomija povezana je s značajno kraćim operacijskim vremenom, kraćom duljinom hospitalizacije i bržim oporavkom ispitanika, te ima manji broj komplikacija i recidiva u usporedbi s otvorenom. |
| Abstract (english) | Objectives: The aim of this study was to compare the outcomes of treatment in children with varicocele between open and laparoscopic surgical techniques, in a six year period at the Clinic of pediatric surgery, Split University Hospital.
Patients and methods: The case records of 537 pediatric patients who underwent varicocelectomy between January, 2012 and January, 2018 were retrospectively reviewed. Patients were divided into two groups, depending on the selected surgical procedure: 142 patients in the laparoscopic group and 395 in the open varicocelectomy group. The groups were compared regarding demographic and clinical data, indications for surgery and outcomes of treatment.
Results: The median age of the patients was 15 years in both groups. Of the total number of patients, left-sided varicocele was found in 533 (99.25%) and bilateral in four patients (0.75%). Of 537 varicoceles, 42 (7.8%) were grade I, 227 (42.3%) grade II and 268 (49.9%) were grade III. Median diameters of veins in varicocele grades I, II and III was 2.9 mm, 3.1 mm and 4.0 mm, respectively. The indications for surgery were: significant decrease in testicular volume in 287 patients (53.4%), scrotal pain/discomfort in 138 (25.7%), abnormal spermiogram in 128 patients (23.8%) and elevated levels of serum LH/FSH in 56 patients (10.4%). The median duration of surgery was 12 min in laparoscopic and 25 min open group (p˂0.00001). The median length of hospital stay was 1 day in laparoscopic and 1.3 days in open group (p=0.0041). A total of 35 postoperative complications were recorded, three (2.1%) in laparoscopic group and 32 (8.1%) in open group (p=0.013). The most common complication was the consecutive hydrocele (n=29, 83%), two (1.4%) in laparoscopic group and in 27 (6.8%) open group (p=0.014). A total of 16 recurrences were recorded, all in open group (p = 0.049). In both groups, sperm concentration (p<0.01), morphology (p<0.01) and motility (laparoscopy, p = 0.02; p<0.01; open varicocelectomy, p <0.01; p=0.04) improved six months after surgery in patients with varicocele stage I and II. In stage III varicocele there was an improvement in sperm concentration (p<0.01) and morphology (p=0.03; p=0.06), while sperm motility (p=0.150; p=0.240) did not significantly recover in any of the groups. Significant improvement in testicular volume occurred in 75% of patients in laparoscopic and in 76.8% in open group. In 82.2% of the patients in laparoscopic and 79.6% of the patients in open group who underwent surgery because of scrotal pain, complete pain relieve occurred.
Conclusion: Laparoscopic and open varicocelectomy are equally effective and result in statistically significant improvement of testicular volume, disappearance of pain, and significantly improves sperm parameters in adolescents. Laparoscopic varicocelectomy is associated with significantly shorter operating time, shorter hospitalization time and faster recovery and has fewer complications and recurrences compared to the open varicocelectomy. |
