ABSTRACT
Background: The link between varicocele and infertility was first reported by cessius in 1st century AD but it was not widely acknowledged until TULLOCH and colleagues reported the improvement of sperm parameters in 26 of 30 patients undergoing varicocelectomy. Varicocele is defined as excessive dilatation of pampiniform venous plexus of spermatic cord. varicocele is an important cause infertility which can be corrected by surgery. Several methods have been used for its treatment including open surgical ligation of spermatic veins as well as laparoscopic varicocelectomy. Open varicocelectomy has more risk of recurrence and complications whereas laparoscopic varicocelectomy is simple, has less risk of recurrence and complication in expert hands. Objectives: To compare Laparoscopic varicocelectomy with open varicocelectomy, in terms of postoperative pain, recurrence rate, hospital stay, cost, cosmetic and complication. To prove hospital stay was more in open group than laparoscopic group and also patient of laparoscopic group return to normal activities earlier than open group. To standardize the laparoscopic varicocelectomy procedure for varicocele. Materials and methods: It was a randomized clinical trial done in Department of General Surgery, Vinayaka Mission Medical College, Karaikal. Study was carried out from 1 st March, 2015 to 1st R. Bharathidasan, Reny Jayaprakash, Subith P. Bhaskar, G. Ambujam. Laparoscopic varicocelectomy now the gold standard procedure for varicocele - A comparative study with open technique based on our experience. IAIM, 2017; 4(7): 218-221. Page 219 March, 2016. A total 70 patients was taken in our study of its 36 patient undergone open varicocelectomy and 34 patient undergone laparoscopic varicocelectomy. Results: Recurrence rate 0% in Laparoscopic Varicocelectomy and 5.6% in open varicocelectomy. Wound complication was 0% in Laparoscopic varicocelectomy and 2.5% in open varicocelectomy. Post-operative pain was more in open group as compared to laparoscopic varicocelectomy. Laparoscopic varicocelectomy has less post-operative morbidity and early return to normal activity. Also there was improvement in seminal analysis in both groups. Conclusion: We would like to standardize laparoscopic varicocoelectomy and make it as a gold standard for Varicocele by replacing open technique provided there is good experienced surgical team and good instrumentation. Cost of the procedure is comparatively high.
ABSTRACT
Background: This study focus on the varying presentation, hormonal influence, and biochemical marker for a series of patient with undescended testis and their influence over descend and imaging modality and various diagnostic approaches towards the undescended testis. Materials and methods: Patients who had attended vinayaka mission medical college, karaikal with the complaints of absence of testis and infertility included in this study and it is a prospective clinical study which was carried from 2014 – 2016 June. All treatment modality were carried out according to the diagnosis confirmed by both clinically and imaging after obtaining concern from the patients. Results: all hormonal and bio chemical marker were taken for all the patients and they were evaluated. In that testosterone showed little on lower side with patients with infertility, insulin like 3 peptide was on lower side for more than fifty percent of patient mainly who were in adolescent age. In patients whose presentation of testis can’t be assessed by either clinical and ultrasonography diagnostic laparoscopy was done and testis were found out. Conclusion: Testosterone has significant effect in descend of the testis and mainly in the patients with infertility. Insulin like peptide 3 can be used as a prognostic marker to assess the viability of the testis and diagnostic laparoscopy remains gold standard invasive diagnostic tool where the testis is not seen clinically and imaging.