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Laparoscopy of varicocele: how to do, recovery after surgery, reviews, price

Drawing pains, the risk of infertility, reduced sexual abilities - the depressing effects of varicocele bring a lot of inconvenience to men.

The elimination of this pathology is increasingly carried out by the modern laparoscopic method, which is better tolerated by patients than other means of correction of the expansion of the veins of the spermatic cord.

What is the difference from microoperative treatment?

In contrast to the operation of Ivanissevich (traditional method of surgical treatment of varicocele), laparoscopic varicocelectomy is performed without a strong incision of the skin in the inguinal region.

Often this method is also compared with a microsurgical operation, which has its own characteristics. Microsurgical method is carried out with a 3-5 cm incision through which the fascia of the spermatic cord is dissected, and then an operating microscope is used. With the help of vicryl ligatures, venous ligation is performed.

With varicocele, laparoscopic surgery has a number of advantages over the microoperative correction method:

  • the intervention does not imply the appearance of deep cuts,
  • the operation is carried out using the camera (maximum visualization),
  • the seam length does not exceed 0.7 mm.

According to statistics, this method leads to only 2% of relapses, while the micro-operative method is 10% or more.
Laparoscopy under the supervision of an experienced doctor also eliminates damage to the lymphatic vessels, arteries and the appearance of common complications in the form of dropsy of the testicles or orchitis of the appendage.

Additional advantage: only this method allows you to identify collaterals - workarounds for blood flow, which with other methods of intervention (including microoperative) can rarely be detected.

Laparoscopy of varicocele: types of operations

Depending on the condition of the man with varicocele, operations with laparoscopy are prescribed various, aimed both at eliminating the pathology and obtaining important information.

Types of laparoscopic surgery:

  1. Diagnostic. In difficult situations, diagnosis of the inguinal vein is required, but often the procedure is not required - it is possible to determine the state of the veins using ultrasound and palpation of the scrotum.
  2. Operational. Intervention is carried out directly to excise the testicular vein. It may immediately include a diagnostic step.
  3. Control. With relapse of varicocele, only a video camera can be introduced into the abdominal cavity, which will reveal the causes of the patient's condition worsening.

Regarding the methods testicular vein embolization, then there are several ways. The introduction of sclerosant (a special suspension) allows you to quickly eliminate a damaged vein, however, the method is contraindicated in patients with cardiovascular pathologies due to the risk of developing a blood clot.

Indications

The presence of bilateral varicocele can be eliminated in one procedure exclusively by the laparoscopic method.

In the treatment relapse varicoceleeliminated by other surgical methods, the laparoscopic method equally demonstrates the rationality of its use due to minimal trauma.

In other cases, two incisions are required that create a noticeable cosmetic defect.

During diagnostic laparoscopy with varicocele also easiest to determine the type of testicular veingoing one trunk or many small vessels (the so-called type of structure of the loose type).

How to prepare for the procedure?

Before surgery will be required pass general testsassociated with the identification or absence of sexually transmitted diseases, HIV and hepatitis. An important value in general blood tests is the number of platelets responsible for the increased risk of increased blood loss during the procedure. If there are no contraindications, a patient with a diagnosed varicocele undergoes further training.

Considering operation under general anesthesia, doctors forbid in the morning to eat and drink water (for 12 hours). The day before the procedure, bowel cleansing is also performed (using an enema) to minimize the appearance of bloating during surgery.

Despite the lack of direct contact with the inguinal region, the doctor will require hair removal near the penis. This procedure eliminates the risks of hair entering the body.

Sequence

A man is injected with a substance that immerses a person in medical sleep, after which three laparoscopic ports are installed on the abdomen.

They are inserted through punctures of the abdominal wall, each element is located in a specific place: a port for a video camera (10 mm) in the navel area, 2 ports for the airway area (5–10 mm) on the right and left sides of the abdomen.

To facilitate the procedure the patient’s body rises 15 degrees for the necessary displacement of some organs located in the abdominal cavity.

When operating the left-sided varicocele, an assistant is on the left side, and a surgeon on the right.

During the operation, a supply of carbon dioxide is also carried out, simplifying the passage of instruments and visual monitoring of the implementation of surgical procedures.

Progress endoscopic surgery for varicocele:

  1. a Veress needle is inserted to fill the abdominal cavity with gas,
  2. the entire testicular vein is examined using a flexible tube with a video camera,
  3. titanium brackets are superimposed on the damaged sections of the vein,
  4. veins intersect between established elements,
  5. endoscopic equipment is removed.
  6. an aseptic dressing is applied to the punctures.

You can see the entire course of the operation in this video:

The total duration of the operation to eliminate varicocele does not exceed 10–45 minutes, and after healing of punctures on the body there are no strong scars and other injuries. Intervention is also possible under local anesthesia if the varicocele has no complications.

Before surgery

  • Preoperative preparation begins in 7-10 days: a complex of blood tests for HIV, hepatitis, RW is performed, the platelet count, prothrombin index are determined, and a general urinalysis is taken.
  • If the test results do not reveal contraindications, preparation continues:
  • examine the vessels of the scrotum using dopplerography,
  • in patients over 15 years of age, they take an ejaculate sample for bacteriological examination and spermograms,
  • perform chest x-ray,
  • take an electrocardiogram.

Refusal to conduct laparoscopic surgery for varicocele follows in cases:

  • impaired hematopoiesis, low coagulability,
  • the presence of adhesions in the abdominal cavity,
  • cardiovascular disorders
  • acute inflammatory processes in the body.

The doctor may prescribe a preventive course of antioxidants and vitamin therapy 10 days before surgery.

For a week, the patient stops taking anticoagulants, for two days - any drugs, alcohol. For 12 hours it is forbidden to eat food, drink should be limited.

At night, the patient is given a cleansing enema, the inguinal region is shaved. On the day of surgery, you can not only eat, but also drink water.

Rehabilitation period: timing, lifestyle, nuances

After the operation, a long stay in the hospital is not necessary - a man can go home in 1-2 days. On the first day, the patient has a mild pain syndrome, which is easily stopped with painkillers with a minimum of side effects (instead of powerful analgesics prescribed after more severe methods of intervention).

Despite a smaller list of restrictions that must be observed after surgery, physical activity is only partially excluded.

Many urologists also distinguish the following relationship between age and the adaptation period - the older the man, the more time he needs to return to his usual rhythm of life after surgery on the inguinal region.

Taboo after surgery:

  • body-building,
  • lifting weights
  • classes on the horizontal bar,
  • constipation.

However, after 2 weeks - in the absence of complications - light physical activity is allowed: brisk walking, swimming, gymnastics, cycling. Active sports can be practiced at the end of 21 days from the date of discharge from the hospital.

Sexual contact and masturbation are also usually permitted after the end of the recovery period.However, you should minimize the excessive load on the press. If during the development of varicocele there were no inflammatory processes inside the testicle, then you can freely return to pregnancy planning.

Laparoscopic intervention is a priority for choice as a therapeutic measure for varicocele. A low percentage of relapses and a quick adaptation process make laparoscopy a promising method for correcting varicose veins of the spermatic cord.

Stages

In the operating unit, the patient is laid on the table. An anesthetist monitors cardiac activity, checks the pulse and sets up a system for intravenous drug delivery and endotracheal anesthesia. Then the surgeon proceeds to the operation.

  1. The patient’s body rises at an angle of 15 °. This is necessary for some displacement of the internal organs. Three punctures are made in the abdominal wall: one, with a diameter of 10 mm, in the umbilical ring, the other two, about 5–7 mm each, on the left and right sides of the iliac region. Flexible tubes - trocars are installed in the sections. A Veress needle is inserted into the umbilical opening and carbon dioxide is supplied. After the abdominal wall is inflated, the needle is removed. A laparoscope is placed in the resulting space.
  2. Under the control of a video camera, surgical instruments are placed in the iliac openings.
  3. To access the vascular bundle of the scrotum, the sheet of the peritoneum at a distance of 3-4 cm from the ring of the inguinal ring is opened.
  4. The testicular vein, arteries, and adjacent lymphatic ducts are secreted using dissectors. Retention is provided by special threads that let down under the vessels. After mobilization of the bundle, the lymphatic ducts are carefully removed to prevent damage.
  5. An artery is separated and removed from the remaining bundle. The remaining testicular vein and the vessels adjacent to it are clipped or ligated with a thread.
  6. Through compression, they ensure normal venous outflow through the healthy vessels of the scrotum and stop bleeding. After a control review, the instrumentation is removed from the abdominal cavity, carbon dioxide is removed. The incisions are sutured or sealed with a sterile dressing.

After waking up from anesthesia, the patient can immediately get out of bed if desired. There are no consequences associated with the state of surgical wounds with laparoscopic intervention. If the well-being in the first hours leaves much to be desired, it is recommended to stay in bed until the discomfort disappears.

Pain after such an operation is less intense than after an open abdominal. Conventional oral analgesics and NSAIDs are sufficient to relieve spasms.

To successfully restore blood flow, the doctor prescribes supportive drug therapy: drugs that improve blood circulation and antiplatelet agents. After 1-2 days, the patient is discharged from the hospital.

Possible consequences of laparoscopy for varicocele:

  1. short-term intestinal paresis associated with exposure to carbon dioxide and manipulations in the abdominal cavity. Symptoms usually disappear within 24 hours
  2. development of hydrocele - testicular edema. The causes are violations of the integrity of the lymphatic vessels. In most cases, the condition stops on its own within a few days or weeks. Occasionally, repeated intervention is required,
  3. scrotum emphysema. It arises with the lack of professionalism of doctors and the accumulation of carbon dioxide residues,
  4. testicular atrophy. It develops in case of violation of the technique of the operation and the intersection of the testicular artery.

For 5–7 days, active physical activity, hot baths are contraindicated. The patient is allowed to walk. It is recommended to relax a lot. Coarse fiber, heavy fatty foods and alcohol must be excluded from the diet.

Within 1–2 weeks, it is recommended to wear a scrotum-supporting suspension - a soft bandage. After the control ultrasound with examination of the vascular bundle of the scrotum, the subsequent recovery regimen is discussed.

From the third week, the patient can begin daily activities, including light sports or physical exertion. To exclude for a period of up to six months, power and extreme forms are required, leading to concussions, compression of the scrotum or increase in abdominal pressure.

Abstinence from sexual intercourse lasts 2–4 weeks. Within 2-3 months, you need to abandon swimming in cold ponds, hiking in the bath, sauna, beach, solarium.

Visible and palpable dilated sections of veins under the skin can last up to 4–5 months, until the complex of collateral vessels is fully active. To accelerate circulation, venoprotective and tonic agents are additionally prescribed.

Adult patients during the period of late rehabilitation conduct a control study of the ejaculate to assess the state of spermatogenesis.

Laparoscopic treatment of varicocele is used as an operation of choice. An undeniable advantage is the cosmetic effect: the places of cuts after healing are almost invisible.

The percentage of relapses with this technique is lower than with similar open access interventions. This is facilitated by an accurate overview and the use of special surgical equipment.

Recording a live broadcast (laparoscopy.rf)

The disadvantage of the operation is considered to be higher than other types of variclectomy, the cost. Such technology is not available to all clinics and patients. Another weak point of laparoscopy is the need for general anesthesia and possible subsequent complications for the nervous and cardiovascular systems.

Varicose veins can affect not only the legs. Today, in 20% of cases, varicocele is diagnosed in men and adolescents. The essence of the disease is that the veins of the scrotum and spermatic cord swell and lengthen.

In most cases, the pathological process mainly affects the veins in the left testicle, although they diagnose a disease in which a symmetrical lesion is observed.

Laparoscopy of varicocele is considered not only one of the effective, but also safe methods to normalize the affected vessels.

Most often, the disease proceeds without a pronounced clinical picture. In this case, the functioning of the testicles occurs without failure. Men may feel slight discomfort and pain in the scrotum. They arise after intense physical activity or playing sports. It is during this period that the testes are deprived of normal blood circulation.

The nature of the pain is pulling, and it occurs at the end of a busy day, when the patient takes a horizontal position. After the night the pain goes away. Also, the disease is accompanied by swelling of the left testicle, as a result of which it hangs down more than the right.

Testicular edema can be observed when the patient is standing, and in a horizontal position, this symptom disappears. A urologist will be able to make a diagnosis after conducting an examination, diagnosis and listening to the patient regarding complaints that have visited him.

Treatment of varicocele is reduced to surgical intervention. But for laparoscopy, you need to carefully prepare.

The first step is a thorough laboratory examination. Thanks to him, it will be possible to detect certain pathologies in the patient - chronic diseases, lung diseases, gastrointestinal pathologies.

All this affects the course of the operation and the condition of the patient.

A general study includes the delivery of a general blood and urine test. Blood is also tested for creatinine, group and Rh factor. Another patient has to pass tests for the prothrombin index and electrocardiogram. It is the doctor’s responsibility to familiarize the patient with information about how the operation will occur, how long it will last, and what to do after it.

Before conducting laparoscopy to remove varicocele, it is important to understand the underlying factor that caused the stagnation of blood in the testicle. After that, taking into account the reasons, they select the type of surgical intervention, during which the man is still able to fertilize. Before laparoscopy, a man shaves his hair, which is located in the area of ​​the surgical field.

With varicose veins of the scrotum, treatment involves the use of an operative path. But only surgical methods include about 120 species. Some of them are still under development, and they are used for medical experiments.

But the positive results that have been tested by practice remain in surgery and are used in various cases of the pathological process.

When is the operation performed?

There are 4 degrees of varicocele:

  1. Testicular varicose veins can only be detected during an ultrasound scan.
  2. Enlarged veins can be felt when a man is standing.

  1. During palpation, regardless of the patient’s position, the doctor clearly palpates the enlarged veins.
  2. Signs of varicocele (dilated veins) can be seen even with the naked eye.

At the last stages of the pathology, a man begins a gradual decrease in spermatogenic function, which can cause infertility. Surgery for varicocele is prescribed for:

  • Identification of any violations of the sperm formation process. A spermogram can show a decrease in the number of sperm, a decrease in their activity, the presence of pus or blood in the ejaculate.
  • If within 1 year or more, subject to regular sexual activity, the couple does not conceive and does not occur pregnancy.
  • A man complains of pain. This can happen in the second or third stage of the pathology. At first, the pain is slight and occurs from time to time. Over time, discomfort intensifies and appears during walking or during physical exertion. Doctors most often diagnose a disease on the left testicle, so pain often occurs on the left.

In more detail about the disease, the general practitioner Elena Vasilievna Malysheva and the cardiologist German Shaevich Gandelman tell:

  • A man may complain about how his scrotum looks.
  • There is a decrease in the size of the testicle.
  • Dropsy of the testicle.

Sometimes the operation is prescribed even to those men whose symptoms of the disease are completely absent. It is believed that timely surgical intervention makes it possible to prevent the development of infertility. Although some argue that this is an unjustified risk, they prefer to monitor the condition of the veins using ultrasound.

As a rule, the procedure is not performed during puberty of the child.According to statistics, if the intervention was performed at a later age, then the likelihood of a relapse when the pathology reoccurs is significantly reduced.

Urologist Iskander Ilfakovich Abdullin tells about the operations performed to treat the disease:

When squeezing veins, a “secondary varicocele” may develop. The cause may be cysts and other neoplasms. In this case, the patient has soreness in the lower back of a dull or stitching nature, blood appears in the urine. In this case, the patient needs treatment of the underlying disease, which provoked a secondary varicocele.

Contraindications

Each intervention technique has its contraindications. Open operations cannot be performed with:

  1. Active inflammatory process.
  2. Identification of cirrhosis of the liver, diabetes mellitus or other decompensation diseases.

Endoscopic surgery cannot be performed on a man who, in addition to the above pathologies, has had abdominal surgery in the past. After such interventions, the clinical picture of the pathology may change. In addition, the risk of medical error increases.

Vein sclerosis has the following contraindications:

  • Identification of anastomoses between vessels. In this case, there is a risk of the drug entering healthy vessels.
  • Increased pressure in the veins of the pelvis.
  • The structure of the vessels is friable, which makes it impossible to introduce a probe into their cavity.

Symptoms of the disease

In most cases, varicocele proceeds in a latent form. The asymptomatic course of the disease is the main reason that patients most often seek help already in the late stage of varicocele. The disease goes through three stages.

In the first stage, there is no obvious symptomatology. During the examination, the main attention should be paid to the condition of the scrotum. In a standing position, the patient sags one of the gonads. In this case, the left gland often changes its position. You can detect this symptom by palpation. However, if you change the position, the sag disappears.

The testicles in the first stage of the disease retain their normal shape. On average, the size of the gland is 3-4 centimeters.

On palpation, the patient may feel soreness. This symptom, as well as palpation of neoplasms or an irregular shape of the glands, rounded small inclusions behind the testicle indicate the need for further examination of the patient.

The first transformations occur in the vascular (cluster-like) vascular bundle. This plexus is used by the body to transport blood to the testicles. The cluster-shaped bundle provides blood circulation around the glands. In addition, this bundle is responsible for the reverse outflow of fluid into the vein bundles. If a man develops a varicocele, an area with deformed tissues appears in the plexus. As a result, the blood goes into a kind of plexus pockets and does not reach the testicles.

In the second stage of the disease, additional symptoms appear. Due to the lack of oxygen in the blood, the glands partially lose their functionality.

For the second stage, the following symptoms are characteristic:

  • perineal pain
  • pulling sensations in the scrotum,
  • deformation of one of the glands,
  • sexual dysfunction.

Pain and discomfort in the scrotum begin to cause trouble in the second stage of the varicocele. Due to insufficient blood supply to the testicles, the production of germ cells decreases. At this stage, difficulties with fertilization appear.

At the third stage of the disease, pathological transformations occur in the testicles. If the patient has not asked for help, atrophic processes in the gland are started.

Preparation period

About 1 week before the proposed operation, a man should undergo a comprehensive examination:

  1. An extensive blood test.
  2. Analysis of urine.
  3. Screening for HIV and hepatitis.

  1. X-rays of light.
  2. Electrocardiogram for patients older than 30 years.
  3. Ultrasound scrotum.

If any abnormalities are identified, the doctor may prescribe additional diagnostic methods.

Immediately on the day of the procedure, the patient should not drink or eat. A man must conduct hygiene procedures (take a shower, shave his pubis). If the patient has any chronic diseases that require taking medication, he should first discuss this with the attending physician.

Causes of the disease

The direct causes of the origin of varicocele in one or another patient remain not fully understood. However, as a result of research, indirect reasons have been established, among which:

  • vascular injury
  • genetic factor
  • lack of certain trace elements in the body,
  • disruptions in the hormonal, muscle or vascular systems.

Thinning of vascular tissue often occurs as a result of mechanical damage. As a result of the injury, the beam structure changes, collagen is washed out of the tissue. Inelastic tissue and the so-called "pocket" are formed on the damaged site. In this cavity, blood gradually accumulates. Under the force of fluid pressure, a vascular node is formed. The formation of a number of nodes is possible if the disease develops for a long time.

The cause of varicocele can be hypovitaminosis. The lack of trace elements responsible for the formation of vascular walls can lead to the development of varicocele. The main element that affects the vessels is collagen. Thanks to collagen, tissues gain elasticity. If there is not enough collagen, the tissues lose their flexibility, conditions are created for the development of the pathological process.

Disorders in the functioning of various body systems can also lead to varicocele. As a rule, this is a problem with the hormonal background, blood vessels and the muscular system.

Surgical Methods

Based on the access method during surgery for varicocele, 2 types of intervention are distinguished:

  • With excision of the re-caval anastamosis.
  • With the preservation of its integrity.

The first method is more effective.

There are 4 ways to perform the intervention:

  1. An open operation (according to Ivanissevich, Marmara or Palomo).
  2. Embolization of varicocele (endovascular sclerotherapy).

Marmar surgery

  1. Laparoscopic varicocele surgery.
  2. Laser procedure.

Options for solving the problem

Laparoscopy is just one way to solve the problem. At the initial stage of the disease, drug therapy is preferred. The choice of specific medications is dictated by the sensitivity to the drugs and concomitant diseases of the patient.

Surgical treatments for varicocele include:

  • embolization (minimally invasive procedure, during which embolization spirals or a sclerosing drug are introduced into the testicular vein),
  • general surgical intervention (methods of Ivanissevich, Palomo, etc.),
  • laparoscopy (also called the endoscopic varicocele surgery).

In previous years, the most common surgical intervention was used. During the operation, the scrotum was completely opened, pathological veins were removed, and sutures were applied to the damaged area.

Scheme of laparoscopic surgery to remove varicocele

However, traditional varicocele surgery is characterized by a number of side effects. The most dangerous complication is infertility of the second degree. In addition, in many patients (in approximately 25% of cases), the disease recurs. As a result, general surgical interventions are currently used much less frequently, since other - more modern - methods of treating varicocele have appeared.

Features of laparoscopy

Laparoscopic varicocele surgery allows you to solve the problem with less likelihood of harm to organs and tissues.The recovery process is much faster than in the case of general surgical intervention, and side effects are less common. The technique of laparoscopy of varicocele has been mastered by many modern surgeons.

The operation is performed through three small incisions in the peritoneum. The main incision is made under the umbilical zone. This notch is used to insert a tube with a micro camera into it. Thanks to the camera, the surgeon receives an overview of the internal organs.

The remaining two incisions are made in the lower portion of the peritoneum. These openings are for insertion of surgical instruments.

On the monitor, the surgeon discovers the place where there are nodes. The doctor compresses the nodes on both sides with the help of clamps. Then the nodes are removed by laser. The edges of the vessels are fixed with special metal staples. Thus, the danger of relapse of the proliferation of the beam is prevented.

When the bond is completed, the surgeon fixes the problem area to a healthy vessel. After this, blood enters the organ through the outflow system. At the final stage of surgery, cosmetic sutures are applied. When complete healing sets in, no noticeable marks remain at the site of surgery.

The total duration of the operation is from 30 to 45 minutes. Short-term anesthesia is used. This method of anesthesia is good in that it does not exert an excessive effect on the cerebral cortex of the patient. Shortly after surgery, the patient regains consciousness.

Finally, the effects of anesthesia cease to be felt approximately 1-2 hours after surgery. A man gains working capacity for 3-4 days, and sexual function for 6-7 days. There is a rapid increase in healthy sperm. Finally, traces of laparoscopy disappear after 2 weeks.

Marmar varicocele operation

The technique of Marmara surgery with varicocele is minimally invasive. For its conduct, the surgeon uses a special microscope. Usually, a microsurgical operation for varicocele is performed under local anesthesia. In this case, the patient will experience a slight tingling or other sensations at the site of the operation. But also Marmara surgery can occur under general anesthesia.

The doctor of urology andrologist Nikolai Konstantinovich Soloviev tells more about the operation on Marmara:

A microscopic incision is performed directly near the ilium. Thus, the postoperative suture will be invisible. Through an incision, the surgeon bandages a vein. After a week, the stitches are removed. Marmar's operation with varicocele is as accurate as possible, so there is practically no risk of accidental damage to blood vessels and arteries.

Conclusion

If any unusual changes in the scrotum are detected, it is recommended that you do not postpone contacting a specialist for advice. If necessary, the doctor will prescribe a full range of diagnostic measures and treatment. The sooner a varicocele is detected, the easier it is to cope with this problem and prevent complications.

The information on the site is provided for informational purposes only and is not a guide to action. Do not self-medicate. Consult your healthcare provider.

Operation varicocele according to Ivanissevich

During the procedure, the doctor performs ligation of the dilated vein. Lymph nodes are not affected. Ivanissevich's operation for varicocele is carried out mainly under general anesthesia.

The length of the incision performed by the surgeon is about 5-10 cm. Having reached the vascular plexus, the doctor carefully separates the lymphatic vessels, and captures the vein with a dissector. After this, her dressing is performed.

Laparoscopy for varicocele - the feasibility of the method and its effectiveness

Varicocele among males is diagnosed on average in 36%, of which 20-90% (research data from various authors) show various disorders of spermatogenesis, and azoospermia in bilateral varicocele. Varicose veins of the plexiform plexus of the testis and spermatic cord in 25% of patients with male infertility are the most likely cause of this pathological condition.

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Currently, the most commonly used surgical techniques for varicocele are laparoscopic surgery and modified microsurgical ligation of the testicular vein according to Marmar. Most urologists andrologists believe that surgical treatment of this pathology is the main method of prevention and one of the most important stages in the treatment of male infertility.

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Sclerotherapy

X-ray endovascular surgery for varicocele is considered the least invasive method. The essence of the procedure is the introduction into the vein of a special substance that glues its walls. The advantage of this method is that the patient does not need to be in the hospital.

During sclerotherapy, the doctor makes a puncture of the femoral vein, where a special probe is inserted, with the help of which an assessment of the state of blood vessels and the introduction of a gluing agent are carried out (thrombovar solution 3%).

Stages of sclerotherapy surgery

To evaluate the result, a contrast agent is injected into the vessels. If the problematic vein does not appear, the doctor concludes that the blood does not enter here, therefore, the operation was successful. Only then can the probe be removed. They resort to embolization of varicocele only at the initial stages of the development of pathology, when changes in the vein are not yet significant.

Preparation for surgery

After examining the patient about the disease and his consent to undergo surgical treatment with laparoscopy, the surgeon-urologist recommends appropriate preparation for surgical treatment.

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It provides for the following studies:

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  1. Clinical and biochemical blood tests and urinalysis.
  2. Chest X-ray and ECG.
  3. Blood tests per group and Rh factor, hepatitis, RW and HIV infection.
  4. PCR tests for the presence of urogenital infections.
  5. Bacteriological examination of urine and prostatic secretion (in persons older than 13-15 years).
  6. Clinical and laboratory analysis of seminal fluid (ejaculate).
  7. Spermograms (in persons older than 13-15 years).
  8. Ultrasound of the genitourinary system with ultrasound dopplerography of the scrotum vessels.

In addition, given the possibility of testicular dysfunction in the postoperative period, even if there are no spermatogenesis disorders before surgery, preparation for laparoscopic surgery for varicocele should include a 10 to 14-day course of antioxidant therapy. These include Vitamax plus with antioxidants (1 capsule once a day, every other day), Triovit (1-2 capsules daily), Antiox Plus (1 capsule before meals with plenty of water) and the addition of vitamin E), "Tri-Vi-Plus" (1 tablet 1 time per day). The last two drugs are not recommended for children under 12 years of age.

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On the eve of the operation in the afternoon you can not eat food, you can only drink still water and tea. At night, a laxative and cleansing enema are prescribed, which is repeated in the morning on the day of the intervention. On the morning of the day of surgery, you can no longer just eat, but also drink.

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About the etiology and pathogenesis, as well as the diagnosis of varicose veins in the testis, read in our previous article: Varicocele.

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The essence of operational technology

After the patient enters the operating unit on the operating table, the anesthesiologist monitors the function of the heart (electrocardioscopy), pulse rate and blood oxygen saturation (pulse oximetry), and the necessary solutions and preparations are administered intravenously. After this, combined endotracheal anesthesia is performed, and then the operation begins.

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Scheme of laparoscopic surgery for varicocele testis

Directly laparoscopy for varicocele technically consists of several stages.

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The imposition of pneumoperitoneum and revision of the abdominal cavity. Through the Veress needle, the anterior abdominal wall is pierced and carbon dioxide is injected into the abdominal cavity. Then the needle is removed, and in the area of ​​the upper edge of the umbilical ring through the skin incision in the abdominal cavity is installed using a trocar tube with a diameter of 5-10 mm. A laparoscope is inserted through it and an overview laparoscopy of the abdominal organs is carried out with the determination of the topographic location of the testicular (testicular) vein.

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The anesthetist puts the patient in the Trendelenburg position, for which the entire operating table is tilted in the head direction. This contributes to the displacement of the intestine and other organs upward. Then, under visual control, with the help of a laparoscope, in a similar manner, 2 additional additional tubes with a diameter of 10 mm and 5 mm are installed (for the introduction of surgical manipulators) - in the iliac region and along the midline above the pubis.

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Providing access to the vascular bundle. Over the testicular vein with the help of monopolar coagulation, stepping back 3-4 cm from the inner ring of the inguinal canal, the parietal sheet of the peritoneum is opened

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The implementation of the mobilization of the vascular bundle. The dissector (a tool for "blunt" separation of tissues without damaging them) mobilizes the entire vascular bundle (artery, testicular vein and lymphatic ducts), at a distance of 1.5-3 cm. Under it, but not tied, the thread separating and holding it .

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Isolation of lymphatic vessels in order to prevent their damage. Lymphatic vessels are also separated from the vascular bundle by the dissector and they are brought out from under the “holder” thread.

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Testicular vein ligation. The artery is accurately and accurately separated from the vascular bundle, and the remaining tissues, together with the veins, are tied with a “holding” thread or clipped with a titanium clip.

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The completion of the operation. Surgery ends with stopping bleeding from small vessels and monitoring the full outflow of venous blood from the testicles. The latter is carried out by compression of the corresponding half of the scrotum. After that, gas is removed from the abdominal cavity, tubes are removed and sutures are applied to the skin.

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The average duration of surgery is 45-50 minutes.

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Non-surgical treatment of varicocele

Treatment without the use of surgical methods is possible only if it is necessary to adjust the hormonal background or normalize the functioning of the testicles. Non-surgical treatment is prescribed for older people and adolescents under the age of 18. For this, venotonics and antioxidants are selected for them. The main objective of such therapy is to prevent the progress of pathology. A full treatment of varicocele at home is not possible.

A lecture on the treatment of pathology without surgery is given by the immunologist Georgiy Ermakov:

Forecast

In most cases, the prognosis after surgery is positive. The risk of relapse when using minimally invasive techniques does not exceed 2%, when using the Ivanissevich technique - 9%.

In about half of men after surgery, the results of spermograms return to normal.

Recovery after laparoscopy

In addition to the usual postoperative complications, which are practically eliminated during surgical intervention using this technique, such basic negative consequences as possible are possible:

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  1. Violation of intestinal motility (paresis) on the first day after surgery, which occurs quite often and is easily stopped.
  2. Relapse of varicocele, which (according to scientific literature) is associated with the presence of collateral veins and is 3%.
  3. The development of hydrocele (dropsy of the testicle), associated mainly with an injury to the lymphatic vessels at the time of their isolation or edema of the surrounding tissues, accompanied by compression of the lymphatic ducts. In this case, there is no need for repeated surgical intervention if the Valsalva test is negative and according to the data of ultrasound dopplerography there is no reverse (reverse) blood flow, that is, renal testicular reflux,
  4. Testicular atrophy in case of accidental intersection of the testicular artery.

Postoperative rehabilitation aims to restore the general condition of the patient and eliminate the main clinical consequences caused by varicose veins of the spermatic cord and the plexiform plexus of the testis.

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Immediately after laparoscopy and for 2-3 weeks, it is necessary to wear tight swimming trunks or use testicles for testicles. It is a special bandage in the form of a bandage that allows you to hold the scrotum organs in an elevated position.

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Activation of the patient is carried out on the second day after surgery. Within 3-5 days, only non-intensive and short-term walking with relatively long rest breaks is allowed. During the first month after the operation, physical activity must be limited - physical education, long walking, running, jumping are not recommended. Permissible physical loads with regard to lifting weights should not exceed 5 kg. It is not recommended to visit the pool, baths and saunas, as well as swimming in cold water.

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In addition, due to surgical trauma and the possibility (although very rare) of the development of orchopathy and / or spermatogenesis disorders (due to temporary deterioration of blood flow) associated with testicular circulatory hypoxia, it is advisable to start drug therapy on the second day of the postoperative period. It must be continued for at least 3 months - this is the period of formation of collateral vessels.

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Drug treatment includes the appointment of taking from the first days of one of the above antioxidant drugs, and from the 10th day of the postoperative period - antiplatelet agents and drugs that improve microcirculation. The most preferred of them are Pentoxifylline and its analogues - Trental, Agapurin and Arbiflex. They are prescribed 100 mg 2 times a day (adjusted for age) in 10-day courses every month for at least 3 months.

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If coarse venous nodes remain in the later recovery period, which do not always disappear immediately, venotonics and venoprotective agents are prescribed - Detralex, 1 tablet twice a day for 1 month. In the case of a clinical effect, the drug is prescribed for another 1 month, but in a lower daily dose (1 tablet), after which it is recommended to take escusan (12-15 drops three times a day) or preparations based on Ginkgo Biloba.

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In the absence of positive dynamics for six months with respect to spermogram data, in order to improve spermatogenesis, it is recommended that the treatment program include hyperbaric oxygenation courses and scrotum irradiation with a pulsed low-intensity infrared laser. The rehabilitation process should be carried out under the control of spermogram and ultrasound dopplerometry. After surgical treatment of varicocele and before the birth of the desired number of children by the patient, he should be observed by an andrologist.

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Thus, the laparoscopic surgical technique for treating varicose veins of the plexiform plexus has certain advantages over open surgical techniques - a cosmetic effect and a slightly lower percentage of negative consequences.

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At the same time, a significant number of surgeons refuse to use it. This is based on:

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  • doubts about the reliability of the difference in the number of complications,
  • the need for endotracheal anesthesia during laparoscopic surgery, which is associated with a higher risk compared with local and spinal anesthesia used in the microsurgical method and open varicocelectomy,
  • later postoperative activation of patients,
  • the need for a longer stay in the hospital,
  • the use of expensive laparoscopic equipment.

All these factors make the laparoscopic technique for this pathology, in their opinion, expensive, inappropriate and unjustified. She and the method of microsurgical ligation of the testicular vein are the methods of choice for bilateral varicocele.

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Laparoscopic varicocelectomy for varicocele

Surgery is the only effective way to get rid of varicose veins in the area of ​​the sphenoid venous plexus. Medicine offers several operational techniques that fundamentally differ in the types of access to the affected area and the execution technique. Laparoscopy for varicocele has a clear advantage over abdominal surgery. This is a gentle treatment using high-tech equipment. It is not associated with extensive trauma to adjacent tissues, allows you to identify "sleeping" altered veins, does not require a long recovery, entails fewer postoperative complications.

Methods of operating varicocele

Of all the diseases, scrotal vein varicosity is among the leaders in the number of proposed methods that are treated surgically. There are about 120 species. Many technologies are under development and are the subject of medical discussions and experiments. But the positive results that have been tested by practice are fixed in surgery and are differentially used in various cases of the disease. Today, Ukraine uses universally recognized methods of surgical treatment of varicocele, which can be classified:

Features of laparoscopic treatment

Access to the altered veins of the scrotum during laparoscopy provides several punctures in the abdominal wall. Carbon dioxide is injected into the abdominal cavity, reaching the volume necessary for the operation. Search and dressing of the changed veins is carried out under the control of a laparoscope. Adjacent tissues and vessels do not dissect, but neatly move apart. Intervention lasts from 15 to 40 minutes, the patient during surgery is under general anesthesia.

The patient himself can choose the elimination of varicocele by this method in the absence of contraindications. In some cases, the doctor recommends laparoscopy. This is the only way to treat bilateral lesions, it allows you to excise and bandage the vessels of both testicles during one manipulation. In the case of a recurrent course of varicocele, a laparoscopic operation can provide a proper overview and find workarounds for the blood flow that feed the expanded areas.

The method is used not only for surgical removal of the formed nodes, but also for diagnostic purposes: for a detailed examination of the inguinal vein, the search for previously undetected varicose vessels, for follow-up examination after surgery.

3. Endovascular embolization

The procedure is carried out with fluoroscopic control.It is based on sclerotherapy of the seminal veins or the introduction of coagulating drugs into them. The quality of this operation is largely determined by the qualifications of the doctor.

All surgical methods for treating varicocele (direct, indirect, mixed) have their own characteristics and limitations. In this regard, laparoscopic surgery lacks many shortcomings, in comparison with other methods. They have proven themselves well where traditional methods fail.

Operational process and video

The operation itself is preceded by a preparatory period. 8-10 days before treatment, the patient undergoes examination, and 12 hours before the laparoscopy, he makes the first cleansing enema of the intestine and excludes the ingestion of food and water. The second enema is prescribed immediately before the operation.

The sequence of procedures begins with a general anesthesia. Then, three trocars are placed on the patient lying on his back. The first is with a diameter of 10 mm and a video camera inside. It is designed to track all processes and is introduced into the umbilical ring. Two second five-millimeter instruments are inserted below the same ring on both sides. The installation of trocars is accompanied by the injection of carbon dioxide. This is done for security purposes.

Then the varicose veins of the spermatic cord are isolated and infused. For this, our clinic in Kiev uses the latest electric welding technologies. When performing laparoscopic variclectomy, we completely abandoned the use of metal clips. Cases when clips fall out and injure the abdominal cavity are not uncommon.

At the end of the operation, carbon dioxide is removed, trocars are removed, patches are applied to the wounds or sutured with catgut.

To understand a more complete picture, below is a video of a varicocele laparoscopy performed in our clinic in Kiev.

Possible complications

A common occurrence after any operation is pain. But after laparoscopy, it is slightly expressed. To eliminate it, a few injections of the analgesic in the first day are enough. Many operated on pain does not need. They are discharged in two days. The maximum patient stay in the hospital lasts no more than a week.

Complications that arise are associated with filling the abdominal cavity with gas, installing trocars and other manipulations. This is expressed in the form of such manifestations:

  • vascular damage
  • hollow organ deformation,
  • shoulder pain.

But the latest designs of needles and trocars can eliminate the negative effects of laparoscopy or minimize them.

Recovery period

After waking up from anesthesia, the patient can immediately get out of bed if desired. There are no consequences associated with the state of surgical wounds with laparoscopic intervention. If the well-being in the first hours leaves much to be desired, it is recommended to stay in bed until the discomfort disappears.

Pain after such an operation is less intense than after an open abdominal. Conventional oral analgesics and NSAIDs are sufficient to relieve spasms.

To successfully restore blood flow, the doctor prescribes supportive drug therapy: drugs that improve blood circulation and antiplatelet agents. After 1-2 days, the patient is discharged from the hospital.

Possible consequences of laparoscopy for varicocele:

  1. short-term intestinal paresis associated with exposure to carbon dioxide and manipulations in the abdominal cavity. Symptoms usually disappear within 24 hours
  2. development of hydrocele - testicular edema. The causes are violations of the integrity of the lymphatic vessels. In most cases, the condition stops on its own within a few days or weeks. Occasionally, repeated intervention is required,
  3. scrotum emphysema. It arises with the lack of professionalism of doctors and the accumulation of carbon dioxide residues,
  4. testicular atrophy.It develops in case of violation of the technique of the operation and the intersection of the testicular artery.

For 5–7 days, active physical activity, hot baths are contraindicated. The patient is allowed to walk. It is recommended to relax a lot. Coarse fiber, heavy fatty foods and alcohol must be excluded from the diet.

Within 1–2 weeks, it is recommended to wear a scrotum-supporting suspension - a soft bandage. After the control ultrasound with examination of the vascular bundle of the scrotum, the subsequent recovery regimen is discussed.

From the third week, the patient can begin daily activities, including light sports or physical exertion. To exclude for a period of up to six months, power and extreme forms are required, leading to concussions, compression of the scrotum or increase in abdominal pressure.

Abstinence from sexual intercourse lasts 2–4 weeks. Within 2-3 months, you need to abandon swimming in cold ponds, hiking in the bath, sauna, beach, solarium.

Visible and palpable dilated sections of veins under the skin can last up to 4–5 months, until the complex of collateral vessels is fully active. To accelerate circulation, venoprotective and tonic agents are additionally prescribed.

Adult patients during the period of late rehabilitation conduct a control study of the ejaculate to assess the state of spermatogenesis.

Laparoscopic treatment of varicocele is used as an operation of choice. An undeniable advantage is the cosmetic effect: the places of cuts after healing are almost invisible. The percentage of relapses with this technique is lower than with similar open access interventions. This is facilitated by an accurate overview and the use of special surgical equipment. Laparoscopy can only be competed by ligation of the testicular vein according to Marmar, carried out by the microsurgical method.

Rehabilitation and doctor's advice

In order to quickly and, most importantly, return to life for a long time after varicocele laparoscopy, not to be afraid of relapses that occur in 10% of cases, you must follow the standard set of rules:

  • until the wounds are completely healed, monitor their condition, avoiding suppuration,
  • change dressings more often
  • exclude within 7 days the pool, baths, sauna,
  • observed by a therapist.

Do not bother with physical work or strength training 15 days after the operation. All active sports during this period can harm the healing process and restore sexual function. If you follow the restrictions, then in the future you can fully enjoy all the joys of life.

How do laparoscopic surgery for varicocele?

Laparoscopy for varicocele has been used for over 20 years and has long been proven to be effective. The purpose of the operation is to block the veins deformed by varicose veins in the spermatic cord and direct the blood flow to another bloodstream.

The main goal of laparoscopy with varicocele is to block the veins deformed by varicose veins in the spermatic cord and direct the blood flow to another bloodstream.

Varicocele laparoscopy is popular for a number of reasons:

  • the possibility of use regardless of the severity of the pathology,
  • the possibility of simultaneous treatment of varicocele in both testicles,
  • low invasiveness due to good visualization of the surgical field,
  • short rehabilitation period,
  • low risk of developing complications and relapses of varicocele,
  • minimal cosmetic defects.

How is the operation

The laparoscopic method provides for several types of intervention - diagnostic, control and surgical. Diagnostic laparoscopy for varicocele is carried out in the case when ultrasound and palpation are not enough to determine the condition of the testis vein.Surgical laparoscopy is often combined with a diagnostic one, and a control procedure is necessary for recurrent varicocele.

Before the procedure, already in the operating unit, the anesthesiologist monitors the work of the heart, pulse rate and blood oxygen saturation, introduces endotracheal combined anesthesia and the necessary concomitant drugs.

Before the procedure, an anesthetist introduces endotracheal combined anesthesia to the patient already in the operating unit.

Laparoscopic surgical treatment of varicocele includes the following steps:

  • Creation of carboxyperitoneum - injection of carbon dioxide into the abdominal cavity to raise the abdominal wall above the internal organs and create an operative space. For this purpose, a puncture is made in the anterior abdominal wall above the upper edge of the umbilical ring with a Veress needle, into which a special tube is placed using a trocar, an endoscope is inserted and the topographic location of the necessary testicular vein is determined.
  • After this procedure, with varicocele, the anesthesiologist tilts the operating table by 45 ° to displace the internal organs to the diaphragm. Then, in the iliac region and in the midline of the abdomen, 2 more tubes with a diameter of 1 cm and 0.5 cm are placed over the pubis for the introduction of manipulators.
  • Providing access to the vascular plexus of the spermatic cord. For this, a parietal peritoneum is opened over the testicular vein using monopolar electrocoagulation.
  • Mobilization of the vascular bundle. A special instrument - a dissector - separates the vascular bundle with a blunt method (without violating the integrity of the tissues) and a thread of 1.5-3 cm is inserted under it.
  • Separation of the lymphatic vessels and arteries from the vascular bundle with varicocele, their removal from under the thread.
  • Ligation of the testis vein. For this, the veins, together with the surrounding tissues, are ligated with a thread. Also, instead of dressing, vein clipping is used - applying a titanium clip to the vascular bundle.
  • The final stage of surgical intervention with varicocele. To restore blood supply in the testis and stop bleeding from small vessels, compression of the affected part of the scrotum is used. Then carbon dioxide is removed from the abdominal cavity, tubes are removed, and sutures are made on the incisions.

At the final stage of the operation, compression of the affected part of the scrotum is used to restore blood supply in the testis and stop bleeding from small vessels.

The duration of the procedure for removing varicocele does not exceed 50 minutes.

Rehabilitation period

Laparoscopy is well tolerated, so in a patient’s hospital no more than 2 days are observed, rehabilitation is completed 14 days after surgery, when the sutures are removed. In elderly patients with varicocele, the recovery period may last longer.

Efficiency returns to the man within 3-4 days, sexual function - within 6 days. The first 3-5 days a calm short walk is allowed, which must be alternated with a long rest.

For 2-3 weeks, a patient with varicocele will have to wear supportive underwear or a suspension (special bandage) to hold the testes in an elevated position.

The final recovery of the body occurs in a month. Throughout this period, a patient with varicocele is under the control of doctors.

To form collateral vessels and restore blood supply to the testis, the patient is prescribed a 3-month course of antioxidants, antiplatelet agents and drugs that improve blood circulation.

If venous nodes are visible for a long time on the scrotum after a varicocele removal operation, venotonics and venoprotectors are prescribed to the patient.

To form collateral vessels and restore blood supply to the testis, the patient is prescribed a 3-month course of antioxidants, antiplatelet agents and drugs that improve blood circulation.

Limitations

You can drink and eat food only a few hours after the procedure with the permission of the attending physician. During the day after the operation, it is necessary to observe strict bed rest.

Dressings are removed only 48 hours after surgery. All this time, a patient with varicocele is forbidden to wash and wet the postoperative field. For another 7 days after discharge, you can not take a bath and wet the puncture site during hygiene procedures.

The patient should not wear underwear made of synthetic materials.

After varicocele surgery, you can engage in sports, lift weights, and lead an active lifestyle only with the permission of the attending physician, who individually determines whether the regeneration of damaged tissues has completed and whether the blood supply to the testis has been restored.

Within a month after laparoscopy, sports related to weight lifting (maximum permissible weight - 5 kg) and other power loads are prohibited. Gymnastics, walking are allowed. Active sports can be resumed no earlier than 21 days after the operation to remove varicocele.

Sports activities can be resumed no earlier than 21 days after the operation to remove varicocele.

After the procedure for restoring blood supply to prevent relapse of varicocele, it is important for a man to adhere to a diet. This will reduce blood viscosity, strengthen blood vessels, relieve swelling. For this purpose, you need to take food in small portions 5-6 times a day, uniformly loading the digestive tract and vascular system, do not overeat at night, do not drink with food.

The menu should contain proteins, polyunsaturated fatty acids, vegetable oils, fat-soluble vitamins, zinc and selenium.

For this purpose, the following products must be introduced into the diet:

  • greens (celery, cilantro, spinach, parsley),
  • vegetables (carrots, cucumbers, pumpkin), legumes,
  • fruits (avocado, bananas, citrus fruits, cherries),
  • berries (raspberries, currants),
  • nuts
  • eggs
  • meat,
  • sunflower seeds
  • vegetable oil (olive, sunflower, sesame, linseed),
  • seafood (seaweed, fish, mussels, oysters),
  • spices (curry, thyme, turmeric, ginger root),
  • bran bread
  • honey, dark chocolate, dried fruits (dates, dried apricots, prunes),
  • sprouted wheat.

After the procedure for restoring blood supply to prevent relapse, it is important for a man to adhere to a diet. Fresh vegetables and herbs should be added to the diet.

It is important to follow a drinking regimen. You need to drink at least 2 liters of fluid per day, it can be tea, a rosehip broth, cranberry or lingonberry juice, natural juices.

Alcohol, animal fats, simple carbohydrates, caffeine, strong meat broths, and smoked foods negatively affect the state of blood vessels.

Sex life

Despite the fact that an erection is restored within the first week after the procedure, it is recommended to begin sexual activity no earlier than 14 days after surgery on a varicocele and only with the permission of the attending physician. The concentration of ejaculate and spermogram return to normal one month after laparoscopy.

Diet

During rehabilitation, there are no restrictions on food intake. However, it is recommended to adhere to a healthy diet: eat more fruits and vegetables, dairy products. You should also limit the use of foods that cause constipation. Problems with stool can cause severe pain and adversely affect recovery after treatment for varicocele.

Reviews

Andrey, 35 years old, Orenburg: “I got rid of varicocele with the help of laparoscopy. I was satisfied with the procedure: quickly moved away from anesthesia, rose to his feet after a few hours. I left the clinic every other day. True, the cost of the service is not cheap. Recovered quickly.

He regretted that he had not decided on the operation for a long time and suffered unpleasant pains. ”
Love, 43 years old, Rostov-on-Don: “My husband began to complain of constant pain in the scrotum.We went to the doctor and found out that he had a varicocele of the first stage. The doctor talked about various ways to solve the problem.

We chose laparoscopy, which we did not regret. All examinations were quickly completed and surgery was performed. After 3 days, the husband was already at home, and after a month he completely returned to a normal lifestyle. ”
Sergey, 50 years old, Yekaterinburg: “I have detected a varicocele.

Of all the ways to get rid of the disease, I chose laparoscopy. Much has been said about the advantages of the method. The operation was quick, and also recovered in a short time. However, not even a year had passed before the dropsy of the testicles began. And again the examinations, hospitals, surgery began.

I heard a lot of positive reviews about the laparoscopic method. It’s possible that in my case I’m just unlucky, but I will no longer agree to laparoscopy. ”

Egor, 20 years old, Khabarovsk: “With the passage of the commission when I was drafted into the army, they revealed a varicocele. Gave a respite and advised to do laparoscopy.

I did not postpone it, immediately went to the hospital, passed all the tests. We performed laparoscopy, the next day I was already at home. He quickly recovered, served in the army, and now began to work.

There were no more problems; the varicocele did not re-develop. ”

Laparoscopy in the treatment of varicocele Link to main publication

Laparoscopy in the treatment of varicose veins in the scrotum

Varicose veins can affect not only the legs. Today, in 20% of cases, varicocele is diagnosed in men and adolescents. The essence of the disease is that the veins of the scrotum and spermatic cord swell and lengthen.

In most cases, the pathological process mainly affects the veins in the left testicle, although they diagnose a disease in which a symmetrical lesion is observed.

Laparoscopy of varicocele is considered not only one of the effective, but also safe methods to normalize the affected vessels.

Most often, the disease proceeds without a pronounced clinical picture. In this case, the functioning of the testicles occurs without failure. Men may feel slight discomfort and pain in the scrotum. They arise after intense physical activity or playing sports. It is during this period that the testes are deprived of normal blood circulation.

The nature of the pain is pulling, and it occurs at the end of a busy day, when the patient takes a horizontal position. After the night the pain goes away. Also, the disease is accompanied by swelling of the left testicle, as a result of which it hangs down more than the right.

Testicular edema can be observed when the patient is standing, and in a horizontal position, this symptom disappears. A urologist will be able to make a diagnosis after conducting an examination, diagnosis and listening to the patient regarding complaints that have visited him.

Methods of surgical intervention

With varicose veins of the scrotum, treatment involves the use of an operative path. But only surgical methods include about 120 species. Some of them are still under development, and they are used for medical experiments.

But the positive results that have been tested by practice remain in surgery and are used in various cases of the pathological process.

To date, the following most popular methods of surgical intervention can be used to treat varicocele:

  1. Traditional operations. These include surgical interventions by Palomo and Marmara. Most often, it is the latter option that is used. This is due to the fact that such an operation least injures the lymphatic vessels and arteries of the testicles. However, in medical practice, when an adult and a pediatric varicocele are removed, the operation of Ivanissevich is most often involved.
  2. Microsurgery. Using this technique, a microscope and binocular glasses are used.Due to the high degree of accuracy of the process, it is possible to understand the right place and bandage the varicose veins, while not touching the testicle and spermatic cord.
  3. Endovascular embolization. This treatment option is carried out using fluoroscopic control. The essence of the procedure is that the seminal veins are sclerosed or coagulating drugs are injected into them. For the operation to be carried out quality, it is necessary to take into account the level of qualification of a specialist.

All the presented varicocele therapy methods are characterized by their features and limitations. In this sense, laparoscopic surgery does not have multiple disadvantages compared to other methods. Varicocele laparoscopy is in great demand where classical methods do not have the desired effect.

Effects

You need to understand that any surgical intervention carries a certain danger to the body. Thus, after the operation, complications may develop, which it is important to deal with as soon as they make themselves felt.

The most common consequence after laparoscopy is pain. But the pain is mild. To get rid of it, you need to do a couple of injections of an analgesic in the early days. But not everyone can take painkillers. They are prescribed after two days.

The maximum patient stay in the hospital will be 7 days.

The resulting consequences can occur due to the fact that the peritoneal cavity is filled with carbon dioxide, trocars are installed and other manipulations are performed. This can be expressed in the following manifestations:

  • vascular injury
  • hollow organ deformation,
  • pain in the shoulders.

Since today the instruments used in laparoscopy are advanced, thanks to them it is possible to eliminate the harmful effects after surgery or to minimize them.

Laparoscopy of varicocele - rehabilitation

After laparoscopy, the patient can quickly return to normal life, without fear of relapse, if you strictly adhere to the doctor's recommendations. The rehabilitation period involves the observance of such simple rules:

  1. until the wounds have healed, assess their condition so that suppuration does not occur.
  2. Change dressings as often as possible.
  3. During the week do not use the pool, sauna and baths.
  4. Observe a doctor.

During the recovery period, you can not actively engage in physical activity or sports. Strength training is allowed 15 days after surgery.

All active sports at this time can adversely affect the healing and restoration of the reproductive system.

If all of the indicated prescriptions of the doctor are fulfilled correctly, then after a short period of time the man will be able to enjoy all the joys of life.

Disease prevention

Pathological changes in the vessels of the scrotum cannot be prevented. But an important preventive method is the examination of the testicles. If it is healthy, then an adult male will have a length of 4 cm and a width of 3 cm.

Moreover, it is located at different levels: the first will be higher than the left. Inspection of the testicles is necessary every month so that it is possible to detect changes in the shape of the size of the scrotum and testicles in a timely manner.

During the inspection, it is important to pay attention to the following pathological changes:

  • Seals or bumps in the equal or left testicle,
  • Fluid formation in the scrotum,
  • Sensations of heaviness in the scrotum, pain or discomfort in the testicle and scrotum,
  • Swelling and enlarged testicles.

Testicles with varicocele are characterized by an elevated temperature of 2 degrees. When pathologists are eliminated, the temperature drops to normal, and all the symptoms of the patient also disappear completely.

Laparoscopy is an effective treatment for scrotal varicose veins in men. Thanks to it, it is possible to normalize the affected vessels and solder them.The method under consideration is considered not only one of the effective, but also safe.

Laparoscopy can only be performed after the cause of the pathology has been precisely determined. They perform it under anesthesia, and after 7 days the patient is discharged home.

The risk of developing complications is minimal, and they can arise only due to non-compliance with the doctor's recommendations during the rehabilitation period.

Before laparoscopic surgery

Preparation for laparoscopic surgery for varicocele requires a standard medical examination. You can pass the examination 7-10 days before treatment at the clinic.

In addition, laparoscopic surgery requires bowel preparation. On the evening before surgery and in the morning before treatment, cleansing enemas are necessary. This will reduce the gas contamination of the intestine.

Laparoscopic surgery for varicocele is performed under general anesthesia, therefore, on the evening before treatment and in the morning, you are not allowed to eat or drink.

After laparoscopic surgery, you will need to be monitored for one day in the hospital.

Technique of laparoscopic surgery

During laparoscopic surgery with varicocele on the operating table, you will be in a supine position. After providing you with anesthetic benefits, trocars will be placed in your abdomen.

Picture. The scheme of installation of trocars during laparoscopic surgery for varicocele.

For safer work, carbon dioxide is injected into the abdominal cavity, before or after the installation of the first trocar.

The first ten-millimeter trocar is installed in the region of the umbilical ring, video equipment is introduced into its lumen, which ensures the display of the surgical field on the monitor. Two five-millimeter trocars are mounted on either side of the umbilical ring, as shown in the figure. Next, the selection of the dilated veins of the spermatic cord and their ligation begins.

Currently, special clips are widely used for ligation of blood vessels, as shown in the figure.

Picture. Vienna on which clips are imposed.

After ligation of the veins, the membranes of the spermatic cord are sutured. The operation ends with the extraction of trocars and suturing wounds.

After laparoscopic surgery

After treatment, you will wake up in the awakening room, after a full recovery of consciousness you will be transferred to your stay ward.

As a rule, after laparoscopic intervention, the pain syndrome is slightly expressed. But if you experience discomfort or pain, notify your medical staff. Non-narcotic pain medications can easily cope with pain and discomfort.

Within a few hours after the operation, you can drink, and eat in the evening.

Laparoscopic varicocelectomy is slightly traumatic, so within a few hours after waking up, you can get out of bed and move around on your own.

The next morning you can head home. Full recovery after treatment takes no more than 2-4 weeks.

Comparison of laparoscopic and microsurgical surgery for varicocele

In this section, we present the results of studies published by the journal Laparoendoscopic Surgery, which are devoted to comparing laparoscopic and microsurgical methods of treating varicocele.

The duration of laparoscopic and microsurgical operations is approximately the same and is a minute. Pain after both operations is slightly expressed. After laparoscopy, an earlier recovery and return to normal activity is noted.

The main disadvantage of laparoscopic surgery for varicocele is the high frequency of hydrocele formation and relapse. This is due to insufficient visualization of the lymphatic vessels during surgery.

How much does varicocele surgery cost?

The cost of the operation to remove varicocele may vary depending on the region and the selected clinic. In Moscow, an open operation will have to pay from 8 thousand rubles. In the regions, the same operation will cost an amount starting from 5 thousand rubles.

About the same cost is the sclerotherapy procedure.

For more information about the postoperative period, see the video:

Laparoscopic surgery costs an average of 15-25 thousand rubles. The cost of varicocele surgery according to Marmar will cost the patient 20-30 thousand rubles.

According to patients' reviews, the operation to remove varicocele is well tolerated by them. Is it possible to have children after varicocele surgery? Surgery for patients with this diagnosis in most cases becomes the only opportunity to become a father.

Varicocele surgery: before and after reviews

Varicocele is a disease that relates exclusively to the male population. It is a varicose vein in the testes. The most effective way to treat this pathology is surgery. Consider how is the operation of varicocele, reviews before and after it.

Laparoscopy for varicocele: reviews before and after

The laparoscopic method for removing varicose veins in the testes is used for bilateral varicocele. This operation is performed under general anesthesia. The essence of laparoscopy is that the surgeon makes 3 small incisions in the abdominal cavity.

A tube with carbon dioxide is passed through one hole, which gives space for the doctor’s actions. After that, a laparoscope with an attached camera is inserted into the abdominal cavity. This will help to see the abdominal cavity on the monitor.
The remaining incisions are necessary for the introduction of surgical instruments.

The affected vein is cut and separated. After carrying out such actions, the tools are removed, the cuts are sutured.

Reviews about this method of removing varicocele are mostly positive. This is an effective and highly effective type of surgical intervention. Laparoscopic surgery for varicocele has the following reviews:

  • helps to accurately determine the number and location of affected blood vessels,
  • minimizes the trauma of healthy veins, lymph nodes,
  • does not require additional incisions even with bilateral testicular damage,
  • the rehabilitation period does not take much time.

The duration of the operation is no more than 1 hour. The rehabilitation period lasts about 3 days. Full recovery occurs 2 weeks after laparoscopy.

Reviews of varicocele embolization also indicate that this type of intervention in extremely rare cases causes complications.

According to statistics, the number of men who have negative consequences or relapse is not more than 5%.

As for the reviews of specialists about laparoscopy with varicocele, they say that this method of treatment is one of the simplest and safest methods for removing varicose veins in the testicles. The patient quickly returns to a normal full life.

Marmara operation: before and after reviews

This is one of the most effective and safe microsurgical methods for removing varicocele. Reviews of patients who have experienced this method of treatment on themselves, speak of such advantages:

  • repeated development of varicose veins in the testes is observed in extremely rare cases,
  • minimal tissue trauma,
  • the scar after the procedure remains very small - no more than 2 cm in length,
  • lack of pain during the rehabilitation period.

A man after Marmara’s surgery very quickly returns to a normal, full life.
Preparing the patient for surgery involves the following activities:

  • do not take aspirin a week before the procedure,
  • 8 hours before Marmara’s surgery, a man can eat food for the last time,
  • quit smoking a day before the procedure,
  • in the morning before surgery, the man must make a cleansing enema and shave off all the hair in the inguinal zone.

Also, some experts recommend taking anti-inflammatory and antibacterial drugs 3 days before the intervention. This will help to recover after the procedure in a short time.
The technique of conducting the Marmara operation consists in the following actions of the surgeon:

  • the doctor makes an incision on the skin no more than 2 cm in length,
  • the spermatic cord is removed into the wound,
  • the affected vein is in the spermatic cord, and it should be found at this stage,
  • a vein affected by varicose veins is bandaged.

The operation of Marmara is carried out using a surgical microscope, which allows you to accurately determine the affected blood vessel.
Bandaging the vein eliminates the occurrence of relapse.

After this procedure, the incision is sutured, a drainage is inserted into it and a gauze dressing impregnated with an antiseptic is applied.

The duration of this type of surgery is no more than 45 minutes.

Reviews of men who underwent Marmara surgery are extremely positive. They have the opportunity to return to normal life a week after its implementation. The only drawback of this intervention is its high cost compared to other varicocele treatment methods.

Pain with varicocele

Operation Ivanissevich: reviews before and after

This type of surgery is performed under local anesthesia. To remove a pathological vein, such manipulations are performed:

  • an incision is made on the iliac region,
  • the affected vein is isolated, isolated and bandaged,
  • after removal of the blood vessel, the wound is sutured.

Reviews of men after the operation according to Ivanissevich are mostly negative. In modern clinics, this method of treatment of varicocele is practically not used. This is associated with an increased risk of injury, a long recovery period, as well as a large scar.

Varicocele treatment without surgery: before and after reviews

Treatment of varicose veins without surgery is advisable only at stages 1 and 2 of the disease. In other cases, this method of exposure is ineffective, it can even worsen the condition of the patient.

For to start non-surgical therapy with the development of varicocele, you need to contact a specialist andrologist. There are many treatments that most of them should be combined.

There are such methods of exposure:

  1. Treatment with folk remedies. Alternative medicine suggests treating varicose veins in the testicles with local baths, tinctures for oral administration, compresses, infusions.
  2. Homeopathy. Homeopathic remedies also show high effectiveness in the treatment of varicocele. These drugs have medicinal properties that help to avoid surgical intervention. Their use is advisable in cases where testicular varicosity does not cause pain in a man.
  3. Physiotherapy. Special exercises and massage of the testicles help normalize local blood circulation. They are aimed at stimulating venous cleansing, and also contribute to the outflow of blood from the spermatic cord.

Reviews about the treatment of varicocele without surgery are fundamentally different. Some men believe that such therapy helps to avoid surgery, but subject to regular necessary procedures. The other part of patients who were treated with drugs did not notice the desired result. They had to resort to an operation.

Varicocele surgery in adolescents

The development of varicocele in adolescence is a serious danger for boys. Since prolonged exposure to this condition can lead to irreversible infertility. And also this disease can cause inflammatory processes that lead to damage to the pelvic organs.

An elevated temperature in the scrotum can gradually lead to testicular atrophy.
Specialists are very cautious about surgical intervention in adolescents. The operation is prescribed only at the 3 stages of the disease. Adolescence is optimal for surgery.

Reviews after varicocele surgery in adolescents suggest that the optimal age at which the boy fully recovers in a short time is 11-12 years. Surgery at an earlier age may lead to repeated testicular varicose veins in the future.

The safest method of surgical intervention in adolescents is laparoscopy. But the choice is made only by the attending physician, taking into account the individual characteristics of the course of the disease in the boy.

Can varicocele cause infertility

Recovery after varicocele surgery

In order to fully recover, as well as to avoid relapse, a man must adhere to these rules:

  1. Restriction of physical activity. A man should avoid wearing heavy objects, as well as perform physical actions that expose the abdominal muscles to overstrain.
  2. Compliance with the diet. It is required to choose a balanced diet that will prevent the appearance of constipation. When excreting feces with such a malaise, blood circulation in the pelvic organs is disturbed, which leads to repeated varicocele.
  3. Moderate sexual activity. In the first month after the operation, you should completely refrain from sexual contact. In the future, you need to take care of regular sex life - sexual contacts should be at least 2-3 times a week. During rehabilitation, masturbation is also contraindicated.
  4. Give up bad habits, such as smoking and excessive drinking. They lead to dehydration, resulting in prolonged constipation.

After surgery, one should strictly adhere to the recommendations and prescriptions of the attending physician. Also, every six months a man should visit a urologist for preventive examinations. This will help to timely detect the reappearance of varicocele.

Varicocele Prevention

It is impossible to avoid the appearance of varicose veins in the testicles of a man by taking preventive measures. Since this pathology develops as a result of a genetic predisposition or disorders of the circulatory system. The main task of a man is to seek help from a specialist in a timely manner. Examination and consultation require the following symptoms:

  • the appearance of seals in the testicles when probing the scrotum,
  • Excessive fluid in the scrotum
  • a feeling of heaviness in the groin area,
  • pain in the scrotum during and after intimacy,
  • swelling, enlargement, or asymmetry of the testicles.

These signs are characteristic of varicocele. Therefore, when they appear, you must immediately contact a specialist. This will help to start timely treatment, that is, to avoid surgical intervention.

Laparoscopy of varicocele in men: stages and the postoperative period

Varicose veins are found not only on the lower extremities, but also on the external genitalia of men and women. In men, this disease is called varicocele. The most effective method of therapy for this disease is surgery, namely laparoscopy. Varicocele successfully passes after such an operation.

Types of operations

Varicocele is a fairly common disease that is characterized by dilated veins in the scrotum. This does not always bring unpleasant symptoms, but is often the cause of male infertility. It is sometimes diagnosed in childhood. It is clear that after the diagnosis is made, it is necessary to immediately begin treatment of varicocele.

With this ailment, conservative medicine, as a rule, does not bring tangible benefits. It can only mask the symptoms, but it will not relieve the problem. Therefore, the best way to treat varicocele is laparoscopic surgery.

According to statistics, this method leads to only 2% of relapses, while the micro-operative method - 10% or more.

With varicocele, a change in the size of the testicle occurs, sperm production is disrupted, which leads to premature menopause in men. Therefore, the operation is done to get rid of this ailment, normalize sex life, restore attraction and spermatogenesis.

As a result, the patient feels much better after surgery, his libido rises, the process of erection is restored, and most importantly, the man can become a father.

Currently, several types of operations are performed with varicocele:

  1. A usual operation according to the method of Ivanissevich, in which an abdominal incision is made under general anesthesia, after which a diseased vein on the testicle is pulled.
  2. Vascular sclerosis, in which a probe with a sclerosing substance is inserted into the testis under local anesthesia. As a result, there is a cessation of blood flow, an enlarged vein returns to normal.
  3. The laparoscopic method is the most optimal of all surgical interventions. Such an operation is considered the safest, because blood loss and subsequent complications are minimal.

The main stages of the operation

The technique of varicocelectomy is not so complicated, it will be described below. After admission to the operating room, the patient enters the operating table. An anesthetist connects heart, heart rate, and blood pressure monitoring.

Then, through the vein, the necessary preparations and solutions are administered. Then the patient is given endotracheal anesthesia.

Laparoscopy for varicocele is not performed in the presence of an adhesion process and serious heart diseases.

The organization of laparoscopy consists of several stages:

  1. At the first stage, three punctures are made in the peritoneum, where carbon dioxide is introduced. From this, the stomach is rounded, which facilitates the implementation of surgical operations. Then the needle is removed, and a laparoscope is inserted into the puncture using a trocar.
  2. Next, the patient must be transferred to the Trendelenburg position so that the intestines are slightly displaced and access to the genitals is freed up. To do this, tilt the operating table. In the other two punctures, the instruments necessary for the implementation of surgical procedures are inserted through the trocars.
  3. Access to the bundle of necessary vessels is provided; for this, the upper layer of the peritoneum is opened. Further, the dilated vein should be separated from other tissues and blood vessels so as not to damage them. The vascular bundle is pulled by a thread or fixed with special clips.
  4. Then stop the bleeding, cauterizing blood vessels. They take out all the tools, pump gas from the abdominal cavity. Punctures are sutured with threads or coated with a special adhesive.

The total operation time is no more than an hour. The removed sections of the vein are usually sent for histological examination.

Advantages over Microsurgery

Experts note some advantages of this operation over microsurgery and other surgical methods.

  • minimum number of postoperative complications,
  • low probability of relapse,
  • small punctures instead of large cuts,
  • seams are not more than a centimeter,
  • short recovery period
  • no damage to the arteries.

But, nevertheless, this operation has some disadvantages:

  • high prices for surgery services,
  • general anesthesia,
  • there is a high probability of complications with insufficient qualification of the surgeon.

Useful video

Laparoscopic surgery in urology:

His son was found on a commission at the military enlistment office - before, doctors did not make such a diagnosis. He himself did not bother, did not complain, he felt good. But a deferment from the army was given and recommended to operate. Did laparoscopy - quickly, got up a few hours later, on the third day they were discharged. According to his son, life has become much nicer, a sense of relief.

He underwent laparoscopy and was quite pleased. True, he did it in a private clinic, but the plus is that they were discharged on the second day. He walked away from anesthesia easily, slept and that’s it. I even regretted that I dragged on with this for so long, I could solve everything much earlier and not endure the discomfort. He earned a varicocele with persistent barbell exercises. Now, of course, you will have to revise the schedule and intensity of training.

Causes

There is no specific reason for the development of the disease. Medicine is not able to answer the question. Many scientists agreed that the appearance of pathology is influenced by factors:

  • Genetic predisposition.
  • Increased pressure in the abdominal cavity, which occurs with difficulty emptying the intestines.
  • Violations of the outflow of blood that occur due to the presence of a tumor in the kidneys or organs of the genitourinary system.
  • Constant physical activity, lifting heavy weight.

The disease occurs due to a lack of collagen in the body, the walls of the vessels become not elastic. In a man, venous nodes in the testis form.

Malfunctions in the work of organs can affect the development of the disease. Varicocele can develop on the background of hormonal failure. To identify the cause of the disease, you must consult a doctor, undergo an examination.

Disease treatment

The disease is not treated with medications. You can get rid of varicocele with the help of surgical intervention. If venous nodes are found in the scrotum, regular therapy is necessary.

There are three types of surgical interventions that are used to treat the disease:

  1. Embolization.
  2. Open surgery.
  3. Laparoscopy.

It is necessary to treat the disease using laparoscopy. Laparoscopic varicocele surgery is a modern method of venous node removal. This type of surgical intervention does not require a large incision. This allows you to avoid the consequences and recover faster after surgery.

The benefits of laparoscopy

Laparoscopy of a varicocele in a man provides not only a normal sex life and getting rid of aching pains, but also increases the chances of conception, improves the quality of sperm.

The main advantage is the minimal time of the operation, which allows short-term anesthesia. Long-term anesthesia affects the brain. Experts do not recommend anesthesia more than 3 times in life. Thanks to laparoscopy, a man quickly recovers and returns to his usual lifestyle, compared with other types of operations.

After this type of surgery, the use of medications is not required, the only condition is antiseptic treatment of sutures. This manipulation is necessary to prevent suppuration.

Another advantage is the quick healing of the joints, which after a few weeks do not leave a mark on the site of the incision.

Laparoscopy for varicocele: how to prepare?

Before laparoscopy, you need to prepare. The patient must undergo some tests to rule out HIV and hepatitis. Before the operation, doctors examine the patient’s blood, paying attention to the platelet count.If their number is increased, doctors prescribe medications to the patient to reduce them, and an increased platelet count in the blood can trigger bleeding during surgery.

The patient is preparing for surgery:

  • Three days before the operation, the man should be excluded from the usual diet: smoked, spicy, fatty and salty foods. Limit intake of foods that cause flatulence and bloating. These include legumes, dairy products, soda and alcoholic beverages.
  • Laparoscopic varicocelectomy occurs under general anesthesia. For this reason, the patient should not eat any food hours before the scheduled operation.
  • 4 hours before surgery is forbidden even to drink water.
  • Before the operation, it is necessary to remove the vegetation in the inguinal region.
  • Immediately before the procedure, a cleansing enema is performed.

Operation

The man is on the operating table. A medication is administered into a vein, which is considered to be "general anesthesia." Doctors are convinced that the patient is in a "medical dream" and begin the operation.

The surgeon makes three small incisions in the abdominal cavity. One of the incisions is carried out just below the navel, it is intended for the introduction of a microchamber, which is necessary for laparoscopy. The second and third incision is necessary for the introduction of surgical instruments. Using the camera, the doctor sees on the screen a site with venous nodes. The specialist installs medical braces on the edges of the venous node, and with the help of a laser, the surgeon removes the varicocele. At the end of the removal of the node, the doctor attaches the damaged area to a healthy vessel, so the blood is sent through the outflow. Next, the doctor applies self-absorbable sutures to the incisions. After a couple of months, not a trace remains in the place of the incisions.

Postoperative period

If there are no complications, the patient is sent home from the hospital on the second day after surgery. To stop aching pain in the area of ​​incisions and the site of the operation, the man is prescribed pain medications.

After laparoscopy, it is necessary to exclude any physical activity, as well as weight lifting. The duration of the load ban depends on the age of the patient and his individual characteristics. The older the man - the more time it takes to restore the body.

14 days after the operation, light physical exercises are gradually introduced in the form of hiking, swimming or gymnastics. After 3 weeks from the moment of surgery, the patient returns to normal. Doctors categorically do not recommend having sex or masturbating for a month after laparoscopic surgery.

If the patient after the operation feels satisfactory and notices any changes in health, then it is necessary to contact a medical institution.

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The degree of development of the disease

  1. The initial stage of the disease, at which there is no discomfort. It is very difficult to diagnose varicocele at this stage, since even palpation is not determined. It is possible to identify only with the help of ultrasound, but since men rarely undergo routine examinations, the initial stage usually remains unattended.
  2. In the second stage, the expansion of veins can be easily detected by palpation. Visually, no deviations are visible.
  3. In the third stage, the enlarged vessels are already visible during the initial examination. There is not even a need for palpation. In addition to dilated veins, significant scrotal deformity is visible.

Some doctors believe that the first two stages do not particularly affect spermatogenesis.But, if specialists, when a varicocele is detected, insist on surgery, then first of all it is necessary to consider the option of laparoscopy.

What is laparoscopy?

Today, if the question is how to treat varicocele, the laparoscopic procedure for removing venous nodes takes one of the leading positions. Laparoscopy is a kind of research method. Previously, two small incisions are made in the abdominal cavity. A thin tube is introduced through one of them, one end of which is equipped with a lens, and the other an eyepiece. More modern equipment has a tube connected to a miniature camera. The resulting image is displayed on the monitor screen. A special device called a manipulator is introduced through the second incision. With it, the doctor displaces the internal organs and carefully examines the abdominal cavity.

Types of Laparoscopy

Three types of laparoscopy are distinguished.

  1. Diagnostic The technique is used to diagnose diseases of internal organs in cases where there is difficulty in making a diagnosis.
  2. Operational. With its help, adhesions or neoplasms are removed, and surgical treatment of diseases of the genital organs is also performed.
  3. Control. Use a video camera to monitor the progress of the operation, as well as in the postoperative period, in case of disputable, doubtful situations.

Preparation for laparoscopy

Before laparoscopic surgery, the patient must undergo a standard medical examination in the outpatient department. Since the operation is planned, it is usually necessary to pass the inspection two weeks before the appointed date. The day before the procedure, they prepare the intestines. The best option is to take Fortrans. It is just designed to cleanse the intestines before surgery. If for some reason this is not possible, then you can do with the usual cleansing enemas, which are done in the evening and in the morning. These procedures will help eliminate excess gases from the intestines, which very often become an obstacle to the successful operation. Since laparoscopy is performed under general anesthesia, the patient is not recommended to eat and drink from the evening, until the procedure itself.

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Laparoscopic surgery for the past three decades has been successfully used to treat many diseases, including varicocele. It does not matter at what stage this pathology is. The result of this operation is a complete disconnection from the bloodstream of the internal spermatic vein. Surgery is performed under general anesthesia. During the operation, three cuts are made:

  • the first 10 mm is made near the navel,
  • the second 5 mm (left iliac region),
  • the third is also 5 mm in size (right iliac region).

During the operation, three incisions are made.

It is this arrangement of the inputs for the laparoscope that makes it possible to get the ideal angle for viewing the inguinal zones. It is also such a diameter of holes that is important. The fact is that special trocars of the same diameter are introduced into these sections, and laparoscopic equipment is already inserted into them. The operation is carried out under the control of the image displayed on the monitor, or, for the old technique, through the eyepiece of the laparoscope. But such equipment is already quite rare. All progressive clinics have already replaced it with a more modern version.During surgery, the surgeon, millimeter by millimeter, looks at the testicular vein throughout its length, starting from the region of the internal inguinal ring and heading upward. As soon as a thorough examination is made, special staples made of titanium alloy are applied to all branches of the vein, and the vessels located between them are excised. As soon as all these manipulations are completed, the spermatic cord membranes are sutured, the trocars are removed, and sutures are applied to the wounds.

Relapse varicocele

Not always surgery can be a guarantee that the disease will recede forever. Sometimes varicose veins on the side where the surgery was performed reappears. One of the reasons for the development of relapse may be an incomplete examination before laparoscopy. Usually, at this stage, an additional vein is not detected, which carries an inflow to the testicular vessel.

In addition, a weak vascular wall becomes the cause of the appearance of new symptoms. Moreover, the process develops in those veins that carry out blood flow, replacing the removed ones. Sometimes there is an expansion of veins on the opposite side.

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Questions and answers

Alexander asks a question:

He quit drinking and with a craving for alcohol lost the desire for sex, what should I do?

Hello. I am 24 years old. There is no constant sex. And he discovered a weak potency. Morning potency is absent for a long time.

What could it be with me?

What tests to pass in advance, so that the results immediately bring to the doctor?

Please help, just a cry from the heart!

Ruslan asks a question:

Hello! The problem is that the member does not fully stand up and then quickly falls, I had a heavy operation in the abdominal cavity 2 years ago and after that there were minor problems with the head, did an MRI of the head, they say vascular malformation of the brain, I really I don’t feel much! Passed all tests, including testosterone, indicators are normal. They advised to do cavernosography of the penis. What would you advise me.

The site materials are not a guide to action and are advisory in nature. Only a specialist can prescribe treatment and make an accurate diagnosis.

Watch the video: Varicocele Repair (February 2020).

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