Microsurgical Subinguinal or Laparoscopic Palomo Varicocelectomy in adolescent patients, which technique is better?

Öz

The indications for surgical intervention in adolescent varicocele cases are restricted. When intervention is necessary, treatment options include the open subinguinal approach, laparoscopic surgery, or embolization. This study aimed to compare outcomes between microsurgical sub-inguinal varicocelectomy and laparoscopic varicocelectomy in adolescent patients. Forty-nine patients under 18 years old who underwent varicocelectomy between 2010 and 2023 were categorized into two groups based on the surgical approach 19 patients underwent laparoscopic varicocelectomy by pediatric urologists, and 30 patients underwent SV by the urology department. Patient records were retrospectively analyzed for age, preoperative symptoms, physical examination findings, ultrasound results, surgical techniques, and postoperative outcomes. There was no significant difference in recurrence rates between subinguinal varicocelectomy and laparoscopic varicocelectomy techniques. However, statistically significant differences were noted in operative duration, hospital stay length, and patient age at the time of surgery between the pediatric urology and urology department groups employing different techniques. Both subinguinal varicocelectomy and laparoscopic varicocelectomy techniques can be considered based on the surgeon's expertise and institutional resources. Regardless of the approach chosen, preserving arterial and lymphatic structures to maintain testicular blood supply and minimize complications is paramount.

Anahtar Kelimeler

• Varicocele
• ,Laparoscopic Palomo
• Microsurgecal Varikoselectomy

Adölesan Hastalarda Mikrocerrahi Subinguinal veya Laparoskopik Palomo Varikoselektomi, Hangi Teknik Daha İyidir?

Öz

Adölesan varikosel vakalarında cerrahi müdahale endikasyonları kısıtlıdır. Müdahale gerekli olduğunda, tedavi seçenekleri arasında açık subinguinal yaklaşım, laparoskopik cerrahi veya embolizasyon yer almaktadır. Bu çalışmada adolesan hastalarda mikrocerrahi subinguinal varikoselektomi (SV) ve laparoskopik varikoselektomi (LV) sonuçları karşılaştırıldı. 2010-2023 yılları arasında varikoselektomi uygulanan 18 yaş altı 49 hasta cerrahi yaklaşıma göre iki gruba ayrıldı. 19 hastaya pediatrik ürologlar tarafından SV, 30 hastaya üroloji bölümü tarafından SV uygulandı. Hasta kayıtları yaş, ameliyat öncesi semptomlar, fizik muayene bulguları, ultrason sonuçları, cerrahi teknikler ve ameliyat sonrası sonuçlar açısından retrospektif olarak analiz edildi. SV ve LV teknikleri arasında nüks oranları açısından anlamlı bir fark yoktu. Bununla birlikte, farklı teknikler kullanan çocuk ürolojisi ve üroloji bölümü grupları arasında ameliyat süresi, hastanede kalış süresi ve ameliyat sırasındaki hasta yaşı açısından istatistiksel olarak anlamlı farklılıklar kaydedildi. Cerrahın uzmanlığına ve kurumsal kaynaklara bağlı olarak hem SV hem de LV teknikleri düşünülebilir. Seçilen yaklaşım ne olursa olsun, testiküler kan akımını sürdürmek ve komplikasyonları en aza indirmek için arteriyel ve lenfatik yapıları korumak çok önemlidir.

Anahtar Kelimeler

• Varikosel
• Palomo Varikoselektomi
• Subinguinal Mikrocerrahi Varikoselektomi

Kaynakça

1. 1. Parrilli A, Roberti A, Escolino M, Esposito C. Surgical approaches for varicocele in pediatric patient. Transl Pediatr 2016; 5: 227-32.
2. 2. Chiba K, Ramasamy R, Lamb DJ, Lipshultz IL. The varicocele: diagnostic dilemmas, therapeutic challenges and future perspectives. Asian J Androl. 2016;18:276- 281.
3. 3. Skoog SJ, Roberts KP, Goldstein M, Pryor JL. The adolescent varicocele: what’s new with an old problem in young patients? Pediatrics. 1997;100:112-121.
4. 4. Roque M, Esteves SC. A systematic review of clinical practice guidelines and best practice statements for the diagnosis and management of varicocele in children and adolescents. Asian J Androl. 2016;18:262-268.
5. 5. Practice Committee of the American Society for Reproductive Medicine and the Society for Male Reproduction and Urology. Report on varicocele and infertility: a committee opinion. Fertility and Sterility. 2014;102:1556-1560.
6. 6. BaazeemA,BelzileE,CiampiA,etal.Varicoceleandmalefactorinfertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol. 2011;60:796-808.
7. 7. Diamond DA, Zurakowski D, Bauer SB, Borer GJ, Peters AC, Cilento GB, Paltiel JH , Rosoklija I, Retik BA. Relationship of varicocele grade and testicular hypotrophy to semen parameters in adolescents. J Urol. 2007;178:1584-1588.
8. 8. Zampieri N, Bianchi F, Vestri E, Patane S, Camoglio SF. Varicocele in paediatric age: Is the scientific community on the correct pathway? Andrologia. 2021;53:e13844.

9. 9. Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny HY, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007;69:417-420.
10. 10. Goldstein M, Tanrikut C. Microsurgical management of male infertility. Nat Clin Pract Urol. 2006;3:381-391
11. 11. Pastuszak AW, Kumar V, Shah A, Roth RD. Diagnostic and management approaches to pediatric and adolescent varicocele: a survey of pediatric urologists. Urology. 2014;84:450-455
12. 12. Shiraishi K, Oka S, Matsuyama H. Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele. Int J Urol. 2016;23:338-342
13. 13. Kolon TF. Evaluation and Management of the Adolescent Varicocele. J Urol. 2015;194:1194-1201
14. 14. Diamond DA. Adolescent varicocele. Curr Opin Urol. 2007;17:263-267.
15. 15. Golebiewski A, Krolak M, Komasara L, Czauderna P. Dye-assisted lymph vessels sparing laparoscopic varicocelectomy. J Laparoendosc Adv Surg Tech A. 2007;17:360-363
16. 16. Yaman O, Ozdiler E, Anafarta K, Göğüş O. Effect of microsurgical subinguinal varicocele ligation to treat pain. Urology. 2000;55:107-108
17. 17. Owen RC, McCormick BJ, Figler BD, Coward MR. A review of varicocele repair for pain. Transl Androl Urol. 2017;6(Suppl 1):20-29.
18. 18. Han DY, Yang QY, Chen X, Ouyang B, Yao B, Liu HG, Zhang H, Xia K, Deng HC, sun XZ. Who will benefit from surgical repair for painful varicocele: a meta-analysis. Int Urol Nephrol. 2016;48:1071-1078.
19. 19. Silay, M.S., et al. Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. Eur Urol, 2019. 75: 448