A COMPARATIVE STUDY OF LAPAROSCOPIC VERSUS OPEN HIGH LIGATION OF VARICOCELE
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Keywords
Varicocele, Laparoscopic high ligation, Open high ligation, Male infertility, Surgical outcomes, Postoperative recovery
Abstract
Background: Varicocele remains one of the prevalent urological affections responsible for perturbed spermatogenesis and hence male infertility. It is common for surgical intervention to be required for the management of varicocele and it is done through laparoscopic and open high ligation. Each of the techniques is used for blocking the refluxing venous blood flow and to regain normal testicular functions. This work aims at evaluating the comparative efficiency, safety and postulated recovery profile of the laparoscopic high ligation to open high ligation in the varicocele group.
Aim: The overall goal of this study is therefore to determine the short term and long-term outcomes that are related to operative time, post-operative pain, complication rates, recovery time and fertility improvement with varicocele recurrence in boys who underwent laparoscopic and open high ligation techniques.
Methods: Clinically significant varicocele was confirmed in 120 male patients for whom they were randomised in this study. The subjects were distributed into two groups, with thirty well-matched patients receiving laparoscopic high ligation, and thirty similar patients receiving open high ligation. Data that was collected comprised pre-operation and post-operation data like operative time, pain, recovery time and other operational complications. Comparison of the outcomes of the two techniques was made using t-tests and chi-square tests.
Results: Present work revealed that laparoscopic high ligation had shorter operative time (mean 45. 2 min) and less post-operative pain (mean VAS 3. 1) compared with the open group (mean 60. 7 min and mean VAS 5. 4, respectively). The laparoscopic group was found to be superior in the number of days to return to normal activity (mean of 7. 8 days) and complications such as formation of hydrocele (3% in the laparoscopic group as compared to 10% in the open group). Still, data on long-term follow-up showed that varicocele recurrence and improvement of fertility were similar in groups.
Conclusion: Laparoscopic high ligation eliminates many disadvantages of open surgical methods, has a shorter operating time, insignificant postoperative discomfort, and short recovery time, which makes it the method of choice for varicocele in the vast majority of patients. As to the long-term results, it does not matter which method was used – laparoscopic or open high ligation. Finally, the effect of varicocele treatment guided by the present scoring system should be tested using large-scale and cost-effectiveness studies to transform the management of varicocele.
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Dr Muzammil Ramzan
Postgraduate Resident, Department of General Surgery, Islam Teaching Hospital, Sialkot Pakistan
Dr Muhammad Aali Farooq
Postgraduate Resident, Department of General Surgery, Islam Teaching Hospital, Sialkot Pakistan
Dr Muhammad Uzair
Postgraduate Resident, Department of General Surgery, Islam Teaching Hospital, Sialkot Pakistan
Dr Maira Naseer
Postgraduate Resident, Department of General Surgery, Islam Teaching Hospital, Sialkot Pakistan
Dr Tayyeb Ashfaq
Registrar Anaesthesia, Islam Teaching Hospital, Sialkot Pakistan
Dr Danish Ranjha
Admin Registrar Urology, Islam Teaching Hospital, Sialkot Pakistan
Dr Abid Raza
Assistant Professor, Department of General Surgery, Islam Dental College, Sialkot Pakistan