ABSTRACT
Several modalities of varicocele treatment are available, however, no therapeutic technique showed its superiority with regard to the other one. To compare the results of three techniques of varicocelecomy. Retrospective Analytical and comparative study of 128 patients treated by of three techniques of varicocelectomy: the opensurgery by retro peritoneal way for 42 patients [GI], the varicocelectomie coelioscopique for 41 patients [GII] and the antegrade scrotal sclerotherapy done for 45 patients [GIII], between march 2001 and January 2009.The mean age was 28 years. The main motive for consultation was represented by the painful varicocele in 67% of the cases, followed by the hypofertility in 20.3% of the cases and the association both in 12,5% of the cases. The varicocele was in leftsider in 71.1% of the cases, to the right side in 5.4% of the cases and was bilateral in 23.43% of the cases. Varicocele was infra-clinical at 6 patients, grade 1 in 16 sides, grade 2 in 105 sides and grade 3 in 31 sides. The numeration, the mobility as well as the morphology of sperm cells were comparable between the three groups. The global rate success was 81.2%, with the highest rate found in the group III which was treated by antgrade scrotal sclerotherapy [84.4%]. The improvement of the parameters of the spermogramme was noted in the three groups, however a statistically significant difference was found only in patients treated by antgrade scrotal sclerotherapy; it mainly concerned numeration and the mobility of spermatozoides. The highest rate of pregnancy was recorded in patients treated by antgrade scrotal sclerotherapy [13.3%]. The main postoperative complications were hydrocele [16%] followed by testicular hypotrophy [3 patients]. Three techniques of varicocele treatment, offer either a similar succes rate, and improvement of parameters of the sperm cells. However, antegrade scrotal sclerotherpy seem to be the best treatment of first intention in proposed, regarding its efficiency, of the ease of its realization, its moderate cost and its feasibility in case of recurrence if varicocele was treated with open way'GIII]
ABSTRACT
The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy. The purpose of this retrospectise study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature. We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance [persistence of symptoms of reflux on treatment], drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy-esophagus. All our patients had a total or partial fundoplication. Our Outcome measures were mortality, morbidity specifically, the conversion rate and functional outcome in the short and medium term. These 24 men and 27 women of average age 38 years [range: 17-71 ans].All patients were approached first by laparoscopy. All our patients had a fundoplication: 44 total, including 10 with section of short vessels [Nissen] and 34 without section of short vessels [Nissen-Rossetti]. The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients [7.8%]. Mortality was nil. The specific complications were observed in 2 patients [4%], a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type Toupet. The non specific complications were dominated by pneumonia in 4 patients [7.8%]. In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphiagia, present in [77%] cases, was transient in 40 patients [62%] and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a recurrence of reflux confirmed by pH monitoring. The laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature