Öz
Amaç: Bu
çalışmanın amacı adölesan yaş grubunda varikosel nedeniyle cerrahi tedavi yapılan
hastaların sonuçlarını sunmaktır.
Gereç ve Yöntem:
Şubat 2012- Şubat 2016 tarihleri arasında varikosel nedeniyle ameliyat edilen
hastaların dosyaları geriye dönük olarak incelendi. Hastalar, demografik
verileri, klinik şikâyetleri, fizik muayene bulguları ve radyolojik olarak
skrotal renkli doppler ultrasonografi (US) sonuçları ile değerlendirildi.
Varikosel, Hoekstra ve ark. yaptığı dilate ven çapının değerlendirildiği
sınıflamaya göre evrelendirildi. Semptomatik evre 2 - 3 varikosel ve testis
boyutlarında küçülme olan hastalara cerrahi yapıldı. Tedavi sonuçları ve
komplikasyonları kaydedildi.
Bulgular: Yaş
ortalaması 13±2 (10-16) olan 14 hasta değerlendirildi. Hastaların tamamı skrotumda ağrı ve şişlik
şikayetleri ile başvurmuşlardı. Hastaların tümünde
varikosel sol tarafta idi. Hastaların
7’si (%50) evre 2, 7’si (%50) evre 3 idi. Cerrahi
yöntem olarak laparoskopik Palomo yöntemi uygulandı. Ortalama ameliyat süresi
28±4 (20-45) dakika. Ameliyat sırasında hiçbir hastada
komplikasyon yaşanmadı. Ortalama hastanede kalış süresi 2 gün (1-3) idi. Ortalama
ameliyat sonrası izlem 12±9 (3-48) ay idi. Kontrolde
hastaların 11’inde varikosel düzeldi, 3 hastada ise evre 3’ten evre 1’e
geriledi. Nüks görülmedi. Sadece bir hastada (%7) hidrosel gelişti.
Sonuç:
Laparoskopik Palomo yöntemini yüksek başarı, düşük komplikasyon oranı, daha az
ağrı, kısa sürede sosyal yaşama dönüş, iyi kozmetik sonuç gibi faydaları
sebebiyle avantajlı bir yöntemdir. Ayrıca single port laparoskopide ise eldiven
yardımı ile hazırlanan torakoport düşük maliyet ve kolay ulaşılabilir olması
sebebiyle tercih edilebilir.
Anahtar Kelimeler
Kaynakça
- 1. Borruto FA, Impellizzeri P, Antonuccio P, et al. Laparoscopic vs open varicocelectomy in children and adolescents: review of the recent literature and meta-analysis. J Pediatr Surg. 2010;45: 2464-9.
- 2. Arnold G. Coran. Pediatric Surgery. 7. Edition, Vol:2, Philadelphia: Elsevier,2012: P: 1003-1020, 2012.
- 3. Palomo A. Radical cure of varicocele by a new technique; preliminary report. J Urol. 1949;61:604-7.
- 4. Ivanıssevıch O. Left varicocele due to reflux; experience with 4,470 operative cases in forty-two years. J Int Coll Surg. 1960;34:742-55.
- 5. Hoekstra T, Witt MA. The correlation of internal spermatic vein palpability with ultrasonographic diameter and reversal of venous flow. J Urol. 1995;153:82-4.
- 6. Pini Prato A, MacKinlay GA. Is the laparoscopic Palomo procedure for pediatricvaricocele safe and effective? Nine years of unicentric experience. Surg Endosc. 2006 ;20:660-4.
- 7. Schiff J, Kelly C, Goldstein M, Schlegel P, Poppas D. Managing varicoceles in children: results with microsurgical varicocelectomy. BJU Int. 2005;95:399-402.
- 8. Hirsh AV, Cameron KM, Tyler JP, et al. The Doppler assessment of varicoceles and internal spermatic vein reflux. Br J Urol 1980; 52:50–56.
- 9. Oyen RH. Scrotal ultrasound. Eur Radiol 2002; 12:19–24.
- 10. Valentino M, Bertolotto M, Derchi L, et al. Children and adults varicocele: diagnostic issues and therapeutical strategies. J Ultrasound. 2014; 8;17:185-93.
- 11. Höllwarth ME. Varicocele. Puri P, Höllwarth M (eds): Pe¬diatric Surgery. Springer-Verlag Berlin Heidelberg, 2006, p:569.4. Liguori.
- 12. VanderBrink BA, Palmer LS, Gitlin J, et al. Lymphatic-sparing laparoscopic varicocelectomy versus microscopic varicocelectomy: is there a difference? Urology. 2007;70:1207-10.
- 13. Yılmaz E, Hızlı F, Afşarlar ÇE, et al. Adölesanlarda tek port yöntemi ile laparoskopik Palomo varikoselektomi. Çocuk Cerrahisi Dergisi 2015; 29:72-76.
- 14. Hao W, Chan IH, Liu X, et al. Early post-operative interleukin-6 and tumor necrosis factor-α levels after single-port laparoscopic varicocelectomy in children. Pediatr Surg Int 2012;28:281-6.
- 15. Chen Q, Zhong L, Wu S, et al. Laparoscopic Varicocelectomy with Single Incision in Children. Urol J. 2015; 23;12:2400-3.
Öz
Aim:
In this study, we aimed to present results of patients operated for varicocele in adolescent age group.
Materials and method: Files
of patients who treated for varicocele were retrospectively investigated
between February 2012 and February 2016. Patients were evaluated according to
demographic data, clinical complaints, physical examination findings and
scrotal color doppler ultrasonography outcomes.Varicoceles were staged
according to the classification to assess the diameters of dilated veins which
described by Hoekstra et al. Patients who
symptomatic Stage 2-3 varicocele and reduced testicle size were operated.
Outcomes and complications of treatment were recorded.
Results:Fourteen
patients with a mean age of 13±2 (10-16) were evaluated. All patients presented with scrotal pain and
swelling. Varicocele was at the left side in all patients. Seven (50%) patients
were stage 2 and 7 (50%) stage 3. The surgery was performed with laparoscopic
Palomo method. Mean operational time was 28±4 (20-45) minutes. None of the patients developed complication
during surgery. Mean duration of hospitalization was 2 days (1-3) and mean follow-up
was 12±9 (3-48) months. Varicoceles were
resolved in 11 and regressed to stage 1 from 3 in 3 patients. No recurrence
occurred. Only one patient (7%) developed hydrocele.
Conclusion:
Laparoscopic
Palomo is an advantagous method with high success, low complications, less
pain, early
return to social life
and good cosmetic
results.
Furthermore, thoracoport prepared using a
glove in single port laparoscopy can be preferred due to low cost and easy
accessibility.
Anahtar Kelimeler
Kaynakça
- 1. Borruto FA, Impellizzeri P, Antonuccio P, et al. Laparoscopic vs open varicocelectomy in children and adolescents: review of the recent literature and meta-analysis. J Pediatr Surg. 2010;45: 2464-9.
- 2. Arnold G. Coran. Pediatric Surgery. 7. Edition, Vol:2, Philadelphia: Elsevier,2012: P: 1003-1020, 2012.
- 3. Palomo A. Radical cure of varicocele by a new technique; preliminary report. J Urol. 1949;61:604-7.
- 4. Ivanıssevıch O. Left varicocele due to reflux; experience with 4,470 operative cases in forty-two years. J Int Coll Surg. 1960;34:742-55.
- 5. Hoekstra T, Witt MA. The correlation of internal spermatic vein palpability with ultrasonographic diameter and reversal of venous flow. J Urol. 1995;153:82-4.
- 6. Pini Prato A, MacKinlay GA. Is the laparoscopic Palomo procedure for pediatricvaricocele safe and effective? Nine years of unicentric experience. Surg Endosc. 2006 ;20:660-4.
- 7. Schiff J, Kelly C, Goldstein M, Schlegel P, Poppas D. Managing varicoceles in children: results with microsurgical varicocelectomy. BJU Int. 2005;95:399-402.
- 8. Hirsh AV, Cameron KM, Tyler JP, et al. The Doppler assessment of varicoceles and internal spermatic vein reflux. Br J Urol 1980; 52:50–56.
- 9. Oyen RH. Scrotal ultrasound. Eur Radiol 2002; 12:19–24.
- 10. Valentino M, Bertolotto M, Derchi L, et al. Children and adults varicocele: diagnostic issues and therapeutical strategies. J Ultrasound. 2014; 8;17:185-93.
- 11. Höllwarth ME. Varicocele. Puri P, Höllwarth M (eds): Pe¬diatric Surgery. Springer-Verlag Berlin Heidelberg, 2006, p:569.4. Liguori.
- 12. VanderBrink BA, Palmer LS, Gitlin J, et al. Lymphatic-sparing laparoscopic varicocelectomy versus microscopic varicocelectomy: is there a difference? Urology. 2007;70:1207-10.
- 13. Yılmaz E, Hızlı F, Afşarlar ÇE, et al. Adölesanlarda tek port yöntemi ile laparoskopik Palomo varikoselektomi. Çocuk Cerrahisi Dergisi 2015; 29:72-76.
- 14. Hao W, Chan IH, Liu X, et al. Early post-operative interleukin-6 and tumor necrosis factor-α levels after single-port laparoscopic varicocelectomy in children. Pediatr Surg Int 2012;28:281-6.
- 15. Chen Q, Zhong L, Wu S, et al. Laparoscopic Varicocelectomy with Single Incision in Children. Urol J. 2015; 23;12:2400-3.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Araştırma makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 9 Sayı: 2 |
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