Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica · 2014
[Effectiveness analysis of a therapeutic strategy for pediatric varicocele. Have we got what we expected?].
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Ayuso González L, González Temprano N, Molina Caballero A Y, Hernández Martín S, Pisón Chacón J, Pérez Martínez A
Аннотация
OBJECTIVE: Optimal treatment ot vancocele in adolescents remains a topic of discussion. Strides in interventional radiology and laparoscopy have allowed us to implement a multidisciplinary therapeutic protocol that aims to get best of both. We evaluate our results.
METHODS: . Retrospective study of pediatric patients treated for varicocele in our hospital under protocol between 2008 and 2013. Once the therapeutic indication is confirmed, through clinical and Doppler ultrasound examination, patients undergo percutaneous retrograde embolization (PRE). We perform laparoscopic varicocelectomy (LV) when the PRE fails, together with lymphatic preservation using blue patent lymphography prior to surgery.
RESULTS: . Fifty-five patients with varicocele were treated at a mean age of 13 years old (range 11-16). PRE was performed in 50 patients (90.9%), with a proportion of remission of 80% by ultrasound study 6 months after PRE. Sixteen patients (29.1%) underwent LV five of whom without prior PRE. Lymphography with patent blue was performed in 13 (23.6%), and single-port surgery in 6 patients. The presence of coils of PRE did not hinder subsequent LV. The remission rate after LV was 100% at 6 months follow up. Two postoperative lymphoceles were recorded, none after patent blue lymphography.
CONCLUSIONS: . We found in this therapeutic sequence a safe and efficient alternative, allowing a minimal surgical invasion and reducing the rate of postoperative lymphoceles.
METHODS: . Retrospective study of pediatric patients treated for varicocele in our hospital under protocol between 2008 and 2013. Once the therapeutic indication is confirmed, through clinical and Doppler ultrasound examination, patients undergo percutaneous retrograde embolization (PRE). We perform laparoscopic varicocelectomy (LV) when the PRE fails, together with lymphatic preservation using blue patent lymphography prior to surgery.
RESULTS: . Fifty-five patients with varicocele were treated at a mean age of 13 years old (range 11-16). PRE was performed in 50 patients (90.9%), with a proportion of remission of 80% by ultrasound study 6 months after PRE. Sixteen patients (29.1%) underwent LV five of whom without prior PRE. Lymphography with patent blue was performed in 13 (23.6%), and single-port surgery in 6 patients. The presence of coils of PRE did not hinder subsequent LV. The remission rate after LV was 100% at 6 months follow up. Two postoperative lymphoceles were recorded, none after patent blue lymphography.
CONCLUSIONS: . We found in this therapeutic sequence a safe and efficient alternative, allowing a minimal surgical invasion and reducing the rate of postoperative lymphoceles.