Features of varicocele after marmara surgery
Marmar varicocelectomy is a type of microsurgical intervention for varicose veins of the testicular plexus.
An indication for surgery is a noticeable discomfort in the scrotum, a decrease in testicular function and a decrease in its size.
Description of the technique
With varicocele, Marmar surgery is less traumatic compared to other varicocelectomy, since it does not require making abdominal wall incisions and does not leave scars and scars. Recovery occurs in the shortest possible period.
Marmara surgery for varicocele is a microsurgical technique that has several advantages:
- microscopic incisions
- short recovery period
- lack of cosmetic defects after the procedure,
- extremely rare cases of complications.
Due to the minimally invasiveness of the method, the procedure can be carried out without subsequent hospitalization of the patient. The effect of the procedure persists for a long time due to the localization of the main artery and the intersection of the veins of the spermatic cord.
Operation Marmara recognized as the most effective at all stages of the disease. The restoration of the childbearing functions of a man after treatment using this technique occurs several times more often than in other methods of surgical intervention.
The disadvantages of the technique include pain during the procedureperformed under local anesthesia and the direct dependence of the success of the procedure on the highly qualified doctor and the equipment used.
However, this drawback does not negate the above advantages of the Marmara operation with varicocele.
The cost of surgery for varicocele Marmara is often attributed to the shortcomings of the technique. The cost of the procedure itself, without the need for a patient in a hospital, starts from 30 thousand rubles.
If the patient wants to apply general anesthesia, from 3 to 5 thousand rubles are added to the cost. Depending on the price category of the clinic, the cost of surgery in Moscow ranges from 150 to 200 thousand rubles.
Such expensive operations are carried out by highly qualified surgeons using special high-tech equipment. Many experts believe that this technique and the result after its application fully justifies such costs.
Indications and contraindications for the use of varicocelectomy
Many modern urological clinics insist on the mandatory Marmara operation in all adult patients with varicocele. However, according to many qualified urologists, surgical intervention is not always advisable.
Indications for surgery depend on the presence of the following symptoms:
- unsatisfactory spermogram as the cause of the patient’s infertility,
- pulling pains in the testicles that increase with time,
- the desire of a man to improve the appearance of the groin.
An operation according to the Marmara technique cannot be performed if the following conditions are met:
- ARVI or ARI,
- clotting disorder
- exacerbation of chronic diseases,
- after heart attacks, strokes, operations on the liver for 6 months.
Indications for the procedure
- The development of pain during urination.
- Constant pain in the scrotum.
It is known that the disease may not manifest itself for a long period of time and the patient does not even suspect the presence of such a problem. One of the serious complications of this pathology is the development of male infertility.In such a situation, only surgical intervention will have the proper therapeutic effect. Therapy should be started as soon as possible after the detection of pathology.
The main goals of treatment
During varicocele therapy, the operation of marmara poses the following main tasks:
- Perform ligation or excision of the affected vein in the testicles.
- Restore normal blood flow to the lesion site.
- The operation from varicocele for marmara is performed to eliminate the cause of the problem and to reduce the risk of relapse.
In the treatment of varicocele, all manipulations are performed using general or epidural anesthesia, or using local anesthetics. The strategy for anesthesia and other manipulations using the Marmara technique is discussed with each patient individually, taking into account the degree of development of varicocele and the results of the examination.
Preparation for surgery
Before the operation, standard studies of the state of the body are carried out. The list of diagnostic measures is as follows:
- Blood tests: for infections, general and biochemical.
- Analysis of urine.
- Examination of doctors with chronic diseases.
Special preparatory measures immediately before the operation is not required. It is enough to carry out the necessary hygiene measures: shower, shaving scrotum. If general anesthesia is expected, 10 hours before the operation, food intake is stopped, and an intestinal enema is done immediately before the procedure.
What are the advantages of this technique
During varicocele therapy, the Marmara operation demonstrates such high efficiency thanks to high-quality modern tools: 1) Binocular, which is used throughout the operation, 2) Microsurgical instruments.
- Marmara surgery can be performed on an outpatient basis and does not imply hospitalization.
- During marmara surgery, the doctor makes a very small incision in the groin area. In the future, the scar formation will be in the area with increased vegetation.
- After the operation of marmara is performed, the risk of re-development of pathology is minimal and is less than 4-6%.
- The rehabilitation period after the operation of the marmara takes a little time. A man can quickly return to his usual way of life after the operation.
- The operation occurs without significant loss of blood.
- The surrounding soft tissue is practically not prone to excessive injury.
- During the operation, the doctor uses a special microscope that allows you to bypass the arteries. During the execution of other surgical therapies for varicocele, the risk of damage to the testicular arteries is up to 35-45%, which leads to a violation of its nutrition and the development of serious complications.
- After the operation, varicocele not only does not recur, but there is also a restoration of male fertility.
- Modern experts prefer this particular method of therapy.
After the operation is completed, the patient has practically no pain. The inflammatory process develops extremely rarely and mainly due to non-compliance by the patient with the recommendations of the attending physician.
Patients can familiarize themselves with the technique of performing the Marmara operation before performing the procedure.
Differences of the Marmara technique from other treatment methods
- Low trauma.
- The length of the cut does not exceed a few centimeters.
- This method is more modern and effective.
- There is a layered access to the area of the inguinal canal.
- During the procedure, there is no need to penetrate the peritoneum.
- The doctor should not perform a dissection in the abdomen.
- After performing all the manipulations, there are practically no scars and scars.
Other abdominal and laparoscopic techniques cannot provide such efficacy and minimal risk of complications.
During the implementation of the modern minimally invasive procedure, the doctor has the opportunity to quickly find and implement dressing of damaged veins in the inguinal canal. For this reason, the relapse rate is minimal.
According to the result of international studies, this minimally invasive technique helps to restore reproductive function in male men several times more often than other surgical methods of therapy.
How is the procedure performed?
Marmara operation is carried out as follows:
- The surgeon makes a small incision in a place located under the inguinal canal. There, division of the testicular veins into several main trunks is carried out.
- Then, using a special microscope tool, the doctor identifies and bandages each section of the trunks individually. Lymph nodes are not affected.
- During the execution of all manipulations, the structures of the spermatic cord are under significant optical magnification, which allows you to perform all actions as accurately as possible, without injuring the surrounding tissue.
- The duration of all manipulations takes about 35-45 minutes.
- In the future, the patient should remain under the supervision of medical personnel for several hours. In most cases, the patient is discharged home on the same day.
In most cases, doctors prefer local anesthetics and refrain from using general anesthesia. When performing a marmara operation, the patient does not feel pain in the testicles.
In some cases, you may experience a feeling of light sipping, which does not cause significant discomfort. A similar effect can occur at the moment when the surgeon pulls out the spermatic cord.
During the operation, some patients may simply fall asleep and wake up after all the necessary manipulations have been completed.
Marmara operation for varicocele: technique
Choosing anesthesia, the doctor focuses on the patient's condition and his wishes. The operation can be performed under general anesthesia.
But at the same time local anesthesia is preferable, which is preferable. When the patient is conscious, he can help the doctor perform the operation more efficiently.
The surgeon may ask the patient to strain and relax in order to examine the small venous branches. In this case, ligation of dilated veins takes place more qualitatively, without affecting the nearby lymphatic vessels and arteries.
Operation of the Marmara varicocele method carried out as follows:
- The surgeon makes a cut length of 1.5-2 centimeters in the sub-inguinal region, finds the spermatic cord and displays it outside.
- With the help of magnifying devices, the testicular veins are examined and their ligation is done.
- After suturing the dilated veins, the wound is drained by a rubber graduate.
- The wound closes with a bandage with an antiseptic.
Marmara’s operation lasts a total of no more than 40 minutes. After the procedure, the patient is recommended to remain under the supervision of a doctor for 2-3 hours. There is no need for hospitalization of the patient.
Some clinics recommend that the patient stay in the hospital from one to three days. In any case, the patient is granted exemption from work for a period of 7 to 10 days.
Particular attention should be paid to preparing the patient for the operation of the marmara. The patient should shave the hair in the scrotum and pubis 12 hours before the procedure.
If during the treatment of varicocele the operation will be carried out under general or spinal anesthesia, then the patient should not eat food and any liquid 6-8 hours before the procedure.The operation of Marmara is carried out in this case strictly on an empty stomach.
Recovery period and possible complications
The incision after Marmara surgery, due to its small size, is delayed quickly enough. Seams imposed by non-absorbable material are removed on the eighth to ninth day. Some discomfort and minor pain in the inguinal region are possible within 2-3 days.
At that time it is necessary to protect the scrotum from friction and other mechanical effects, do not take showers. Baths are not recommended for 2-3 weeks.
The scrotum at this time should be in a state suspended by means of a special dressing to avoid stretching of the skin and rupture of sutures.
During the recovery period - about 6 months - you should not load the body, make sudden movements, catch a cold or hypothermia, visit a bath and sauna, take hot baths.
You can read how to save yourself and what it is advisable to give up during the recovery period here.
3 months after treatment, it is recommended to conduct a spermogram to monitor the restoration of the patient's reproductive function.
In rare cases, mainly in violation of the recommendations of doctors, complications are possible:
- The accumulation of fluid in the testicle and the development of its dropsy.
- Wound inflammation.
- Bleeding from an incision.
- Tangible pains if nerve endings are affected by suturing.
- Allergy to suture thread.
- Some patients report severe pain during sexual intercourse within 3-4 months after surgery. But these sensations pass quite quickly while providing the scrotum with a state of rest.
Sometimes minor pain at the site of the incision during physical activity lasts up to several years, which can be prevented by wearing a special bandage for 6-7 months after the procedure.
How to behave after varicocele surgery? Says Dr. Seymour Mehdiyev:
Relapses of varicocele after Marmara surgery are quite rare. and can be caused by the special structure of the circulatory system in some men. The normal vascular plexus of the veins and their communication with other vessels is sometimes absent, and then blood stagnation begins. With this structure of the veins, the re-development of varicocele of the testicle is possible.
However, there is no confirmation of a 100% restoration of childbearing function after this type of treatment. The ability to conceive is not always restored.
Marmara surgery allows you to cure a patient in just 1 day without a significant risk of complications or a repeated relapse of the pathology. The recovery period after marmara surgery is quite easy for most patients, without complications. After carrying out all the manipulations, a man should not significantly change the daily routine or established lifestyle.
During the first few days after the operation, patients are advised to refrain from any physical exertion. Excessive physical activity will also have to be significantly reduced over the next few months.
In rare cases, the following complications have been reported after surgery:
- Wound infection.
- Dropsy development.
- Re-development of the disease.
After the operation is completed, the patient will be advised to regularly undergo an in-person examination with his attending physician so that he is convinced of the effectiveness of the therapy. Also, the patient will be changed the dressing and control the healing process. Suture removal is carried out after 1 week - 14 days after the procedure.
- General blood analysis.
- General urine analysis.
- Blood chemistry.
- The implementation of the coagulogram.
- Definitions of blood type and Rh factor.
- After the detection of antibodies to hepatitis, HIV infection, after the reaction to syphilis.
Patients should take into account the fact that the tests also have an expiration date: no more than 14 days from the date of their implementation.
In the event that the marmara technique from varicocele will be carried out using spinal anesthesia, it may be necessary to perform an electrocardiogram, as well as a consultation and a conclusion from a physician regarding the man’s readiness for the procedure.
The main contraindications
- Marmara surgery is not performed if the patient has a history of uncontrolled hypertension.
- With exacerbation of chronic diseases: for example, gastric and duodenal ulcers. In this case, the operation of Marmara can be delayed until remission and improvement of well-being of the patient.
- With serious violations of the normal functioning of the blood coagulation system. In the event that the patient is taking drugs from the group of anticoagulants, then their use should be discontinued no later than 10-14 days before the operation of the marmara.
- The recovery period (at least six months) after a heart attack, stroke or coronary heart disease.
The Marmara technique is also not used in case of detection of acute respiratory diseases or flu.
Varicose veins of the scrotum
Varicocele consists in dysfunction of the vein valves, which leads to the expansion of the veins of the testicles and spermatic cord. Valves serve to ensure the movement of blood only in one direction. Varicocele has two main causes: congenital disruption of the valves and increased pressure in the pelvic organs. An increase in pressure leads to deformation of the veins (shape change, kinks, squeezing) and impaired blood outflow from the scrotum.
Symptoms of varicocele:
- Heaviness in the scrotum (at first only after physical exertion, and then all the time).
- Dull or pulling pains in the scrotum.
Varicocele is detected in the diagnosis of infertility, since the expansion of the veins affects the process of sperm formation. Varicocele treatment is aimed at restoring blood flow and normalizing the pressure in the veins that feed the testicles.
The danger of varicocele
Violation of blood flow in the scrotum has many dangerous consequences that affect the well-being of men and their reproductive abilities.
- decreased blood flow to the testicles, which leads to accumulate metabolites and free radicals,
- getting into the scrotum of blood from the kidneys and adrenal glands (blood from the adrenal glands contains a large amount of testosterone),
- testicular overheating against a background of local temperature increase.
Varicocele can cause phimosis (painful exposure of the glans penis due to narrowing of the foreskin). The disease is diagnosed mainly in children. A similar complication indicates not only varicocele, but also problems with the formation of connective tissue.
Varicocele and infertility
In 40% of infertile men, the reason lies precisely in the expansion of the scrotum veins. The process of spermatogenesis is disrupted, the number of germ cells is critically reduced, an excess of deformed spermatozoa is formed. Perhaps even the development of azoospermia (lack of sperm in semen).
The cause of infertility with varicocele may be blood from the adrenal glands entering the scrotum (the veins of the adrenal glands and testicles are located close). The adrenal glands and testes produce testosterone, and with varicocele, blood with a high content of testosterone enters the testes. The body "thinks" that the testicles have produced an excess of the hormone, therefore, reduces its synthesis. Testosterone deficiency is one of the main causes of male infertility.
Normalize blood flow in the scrotum allows surgery.If successful, several months after treatment, reproductive functions and the work of the sex glands are fully restored.
When to perform an operation with varicocele
In the treatment of varicocele, the doctor must determine exactly when the drug treatment is enough, and when the operation is necessary. Since in most cases the disease is diagnosed in adolescents, surgical treatment is postponed, but it is very important to constantly monitor the development of varicocele. Do not allow complication of the disease to grade 3.
Severity of varicocele:
- The first degree is characterized by the absence of pronounced discomfort, the man does not suspect the presence of the disease. Diagnosis of varicocele of the first degree is possible only as part of a routine examination. The Valsalva test (exhalation with a closed mouth and nose) allows you to suspect a varicocele, and ultrasound and Dopplerography confirm it.
- The second degree also proceeds without pronounced symptoms, but a man may experience discomfort after physical exertion. At this stage, normal palpation allows the detection of varicocele. By feeling the doctor can determine the expansion of the veins and assess the condition of the testis.
- The third degree is accompanied by pronounced changes in the scrotum, the patient constantly feels discomfort, and pain occurs after exercise. You can notice the change in the scrotum with the naked eye, there is a visual asymmetry.
The danger of varicocele lies in its asymptomatic behavior. Surgical intervention is necessary at the 2-3 stages of varicocele. However, it must be remembered that at the last stage complicated by testicular atrophy, any treatment will be ineffective.
Features of the operation of Marmara with varicocele
Marmara surgery for varicocele is one of the most effective methods of surgical intervention. Despite the high degree of trauma, after such surgical treatment, the risk of complications and repeated exacerbation of the disease is reduced.
Marmara surgery for varicocele is one of the most effective methods of surgical intervention.
Operation Marmara: indications, conduct, rehabilitation
Varicocele - varicose veins of the scrotum, is one of the most common diseases. According to some reports, it is found in 30% of men. Varicocele can cause infertility and a number of other unpleasant symptoms.Marmara surgery is one of the most promising methods of treating this disease. It is characterized by the least number of consequences and complications compared with other options for intervention.
Indications for the operation
The operation is performed according to the following indications:
- poor sperm count, which can cause infertility,
- pain in the scrotum. The pulling nature of the pain can become more intense. This symptomatic symptom is observed in the later stages of varicocele,
- desire to change the appearance of the scrotum,
- double varicocele in children. Surgery is preferable during puberty, which reduces the risk of testicular dysfunction,
- discomfort in the testicle, aggravated in hot weather and when walking,
- when replacing testicular tissue with connective tissue, which is typical for varicocele 3 degrees,
- phimosis (narrowing of the opening of the foreskin) in most cases is accompanied by varicocele.
The doctor must exclude concomitant diseases when making a diagnosis. These can be benign neoplasms that constrict blood vessels, which is the cause of varicose veins. In this case, the treatment of varicocele is reduced to the removal of the tumor.
Indications for surgery
Many clinics practicing Marmara surgery write about the need for surgical treatment in all people over 18 years old with a varicocele.In fact, many modern urologists agree that this is by no means always the case, the indications depend on the degree of the disease and the symptoms manifested.
An operation of Marmara can be appointed or recommended in the following cases:
- Bad spermogram as a possible cause of infertility along with the patient’s desire to become a father now or in the future.
- Pain in the scrotum. They are pulling in nature and, as a rule, tend to become stronger over time. Such a symptom occurs already in the last stages of the disease, when the veins are easily palpated or visible to the naked eye.
- The patient pursues aesthetic goals and wants to give the scrotum a beautiful appearance.
- Discomfort, a feeling of heaviness in the testicle. Sensations disappear if you raise the scrotum, give it a horizontal position, and intensify in hot weather and when walking.
When making a diagnosis of varicocele, it is necessary to verify the absence of a concomitant disease. In particular, some testicular tumors can constrict blood vessels, obstructing the outflow of blood, and cause expansion of veins. In this case, a varicocele may pass after removal of the neoplasm.
Also, prolonged stagnation of blood can cause replacement of testicular tissue with connective tissue. This phenomenon is observed only in the last stages of the disease.
Marmar operation will have to be postponed when:
- SARS and colds,
- Reception of anticoagulants (substances that reduce blood coagulation)
- Exacerbations of chronic diseases (e.g. gastritis),
- Seasonal allergies
- Within six months after a heart attack or stroke,
- During the recovery period of an organ or organ system (for example, after cirrhosis or at the beginning of diabetes mellitus therapy).
If an operation on varicocele according to Marmar is prescribed, then the following conditions must be met:
- in the presence of chronic diseases, the conclusion of the relevant specialists about the possibility of operating
- before surgery, shave the scrotum and pubis, take a shower,
- Do not eat before surgery. In the evening, it is better to refuse dinner if surgery is scheduled for the next morning.
General list of analyzes
Laboratory examination for varicocele includes a number of procedures:
- blood test for syphilis, HIV and hepatitis,
- biochemical and general blood test,
- Analysis of urine,
- electrocardiogram if the patient is older than 30 years.
Before the operation, the patient must give blood and urine for analysis.
Preparation for the intervention
Before the operation, you must go through a standard list of studies:
- Determination of the presence or absence of certain infections (HIV, hepatitis, syphilis),
- Biochemical, clinical and general blood analysis,
- Analysis of urine,
- ECG (electrocardiogram).
It is also necessary to visit specialists in the presence of chronic diseases and get their conclusion that the intervention at a given time is not dangerous to the patient’s health. After that, with the results of all studies, you need to go to the therapist who will issue the final permit.
Just before the intervention, you need to shave the scrotum and take a shower. If general anesthesia is planned, a consultation with the anesthetist will take place. The operation is performed on an empty stomach, so it is better to refuse dinner on the evening before.
The type of anesthesia is selected according to the indications and wishes of the patient. It can be spinal, general or local anesthesia. The latter is preferable because it makes it easier to recover after surgery.
The patient receives an injection of midazolam hydrochloride and fentanine citrate into a vein.
Note. The first remedy is used as a sedative and antiepileptic drug. Fentanyl Citrate is a powerful pain reliever.It serves as a primary or secondary agent for anesthesia.
The access for the incision is selected subingual - that is, under the inguinal ring. The doctor palpates the indicated area and injects lidocaine and marcaine under the skin, which serve for additional local anesthesia. In the projection of the inguinal canal, the surgeon dissects the tissue. The total length of the cut does not exceed 3 cm. Subsequently, the scar will be practically invisible under the underwear, when bathing, staying on the beach.
With the help of small retractors (tools used to breed the skin), the doctor bends the tissue and dissects the subcutaneous tissue and fascia (membrane) of Scarpa. Under the muscle that lifts the testicle, another analgesic injection is made.
Then there is the allocation of the seminal canal and its removal into the wound. It is fixed with two holders in order not to damage it at the same time and not to cause ischemia of the cord as a result of clamping. After this, veins are secreted and vessels larger than 2 mm in diameter are ligated. For this, silk threads are used.
The operation is performed using magnifying lenses, which are in front of the doctor. This increases the accuracy of the operation, reduces the risk of accidental damage to nerves or arteries. They also use a Doppler sensor, which allows you to accurately determine the type of blood vessels and carry out ligation of only veins. Lymphatic ducts are not affected by this operation.
To prevent spasms of blood vessels, the area of operation is irrigated with a solution of papaverine hydrochloride. It removes the tone of smooth muscles. This leads to an antispasmodic and vasodilator effect.
The patient is asked to carry out the Valsalva maneuver. It comes down to trying to exhale with effort with a closed mouth and nose. This leads to an increase in blood pressure and allows you to detect the remaining invisible vessels.
Sutures are applied to the fascia and skin using absorbable sutures. The patient is sent to the ward. In some clinics, patients can be allowed to go home after only a few hours, in others - hospitalization is 1-3 days. In some cases, non-absorbable suture material is used, then to remove it you will have to come to the clinic or hospital in 7-10 days.
Marmara operation with varicocele
Marmara surgery for varicocele is considered the latest surgical treatment method in our country and abroad. It is necessary to analyze in detail the advantages and disadvantages of this operation, the implementation technique and the features of the recovery period.
Marmara surgery is prescribed for men with complicated varicocele, a pathology associated with testicular varicose veins.
How is the operation
Doctors recommend local anesthesia, as a conscious patient during the operation can, if necessary for the surgeon, strain or relax the abdominal muscles, which allows you to bandage the veins without damaging the lymphatic vessels and arteries.
The patient is given an intravenous injection of Midazolam (has a sedative and anticonvulsant effect) and Fentanyl (a powerful analgesic).
- The doctor palpates the area under the inguinal ring and injects lidocaine into it for additional pain relief. In the projection of the inguinal canal, the surgeon dissects the tissue. The cut length is not more than 3 cm.
- Using retractors, the doctor spreads the skin and dissects the subcutaneous tissue. Under the muscle that supports the testicle, the doctor administers a dose of pain medication.
- The spermatic cord is allocated and fixed.
- Extended veins (more than 2 mm in diameter) stand out and are ligated with silk threads.
- The patient is asked to exhale with effort, closing his mouth and nose. This leads to an increase in blood pressure, allowing you to identify previously invisible vessels.
- Sutures are applied. The surgeon uses absorbable sutures to heal faster.
Before surgery, the patient is given an intravenous injection of Midazolam (has a sedative and anticonvulsant effect) and Fentanyl (a powerful analgesic).
The operation to remove varicocele is carried out using magnifying lenses that increase the accuracy of the procedure, while the nerve plexuses and arteries are not damaged.
To prevent spasm of the vessels, the operated area is irrigated with a solution of Papaverine, which removes the tone of smooth muscles.
After surgical treatment according to the Marmara technique for varicocele for some time, it is impossible to prevent the creation of tension in the pelvic organs. During the first month after radical manipulations, a complete ban on any sexual contact is shown.
With a favorable course of the recovery period after the specified period, the doctor can allow sex life, but in a sparing mode. At first, during intimacy, some uncomfortable sensations may appear, which subsequently disappear.
Properly performed surgery according to the Marmara method to eliminate varicocele eliminates the appearance of any complications. However, in case of violations of the surgical procedure and improper implementation of the recommendations of doctors during the recovery period, the following consequences may develop after surgery:
- wound infection
- pus on the postoperative suture,
- damage to the arteries of the testicles,
- allergic reactions, etc.
Most complications with timely detection are easily eliminated.
The initial price of surgical intervention to eliminate varicocele according to the Marmara method is 30,000 rubles. The cost of the operation increases when you join the following services:
- the use of anesthesia,
- accommodation in the ward (if necessary),
- postoperative dressings,
- inspections, etc.
The cost of the operation to eliminate varicocele directly depends on the qualifications of the specialist, the equipment used, the clinic.
The cost of the operation increases when staying in the ward.
It is possible to conduct a free operation to eliminate varicocele based on the compulsory medical insurance quota. For this, the patient turns to the urological department at the place of residence. If there are sufficient grounds for the indicated treatment, he undergoes a full examination and receives a quota that is valid for a year.
Yuri, 28 years old, Moscow.
More than a year ago, he was diagnosed with infertility due to testicular varicocele. The doctor suggested suturing the veins of the testicles according to Marmar. Surgical intervention and the recovery period were painless. No adverse effects were observed. For six months, the wife is pregnant.
Sergey, 40 years old, Vladimir.
To eliminate the pathology of testicular varicose veins helped the operation, which was done according to the Marmara method. After surgery, there was a slight pain and discomfort, which after a while disappeared. I had to fork out for such drastic measures, but it was worth it.
Operation Marmara with varicocele Link to main publication
Types of surgical intervention for varicocele
There are several methods for performing surgical operations for this pathology:
- Laparoscopic intervention.
- Endoscopic intervention.
- Operation according to the method of Marmara.
- The operation according to the method of Ivanissevich.
- Microsurgical method.
Marmara operation is considered the most progressive method. For comparison, consider other types of surgical intervention.
Operation Marmara: indications, conduct, recovery after
All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting a doctor.
Varicocele - varicose veins of the scrotum, is one of the most common diseases. According to some reports, it is found in 30% of men.
Varicocele can cause infertility and a number of other unpleasant symptoms.Marmara surgery is one of the most promising methods of treating this disease. It is characterized by the least number of consequences and complications compared with other options for intervention. Microsurgical surgery is performed to revascularize the testicle with the replacement of the ovarian vein by the epigastric. This type of surgery is performed under a microscope and involves the stitching of pathological veins into the superficial veins, which do not have blood flow disorders. This type of operation creates favorable conditions for the patient to recover quickly and restore the physiological functions of the body, does not cause complications in the form of dropsy of the testicle, and helps restore normal anatomical conditions in the scrotum. Endoscopy is characterized by the lowest level of surgical trauma, which gives the least risk of complications. The use of an endoscope allows the intervention to be carried out with great accuracy, to exclude relapse after the intervention. After this type of intervention, the patient is in hospital for only two days. Postoperative complications and relapses are minimized. Serious consequences after this type of intervention are rare. In the recovery period, the patient can observe:
Complications after surgery
It is characterized by the least number of consequences and complications compared with other options for intervention.
Microsurgical surgery is performed to revascularize the testicle with the replacement of the ovarian vein by the epigastric.
This type of surgery is performed under a microscope and involves the stitching of pathological veins into the superficial veins, which do not have blood flow disorders.
This type of operation creates favorable conditions for the patient to recover quickly and restore the physiological functions of the body, does not cause complications in the form of dropsy of the testicle, and helps restore normal anatomical conditions in the scrotum.
Endoscopy is characterized by the lowest level of surgical trauma, which gives the least risk of complications.
The use of an endoscope allows the intervention to be carried out with great accuracy, to exclude relapse after the intervention.
After this type of intervention, the patient is in hospital for only two days. Postoperative complications and relapses are minimized.
Serious consequences after this type of intervention are rare. In the recovery period, the patient can observe:
In rare cases, the patient is faced with a relapse. This is due to the structural features of its circulatory system. Normally, the papillary plexus (a group of veins dilated with varicocele) communicates with other vessels and groups of vessels. This ensures a normal outflow of blood. If there are no such compounds (anastomoses), then the blood will stagnate in the veins, causing their repeated expansion.
Operation Preparation Procedure
Preoperative preparation includes:
- Refusal to take drugs containing aspirin seven days before the procedure.
- Refusal of water and food at least 8 hours before surgery.
- If the patient is forced to take vital medicines, they should be drunk with a very small amount of water.
- Setting a cleansing enema.
- In the area of surgical intervention, hair is shaved.
- In some cases, antibiotics, anti-inflammatory drugs, anti-clotting drugs are prescribed. These preventative measures can reduce the postoperative period and accelerate recovery.
Before the operation, the following tests are prescribed:
- analytical blood tests - general and biochemical analysis, standard HIV tests,
- blood test for hepatitis,
Contraindications for Marmara surgery are:
- A sharp exacerbation of chronic diseases.
- The period of 6 months after a stroke.
- Symptoms of angina pectoris or coronary heart disease.
- Contraindications based on test results.
Marmara operation - testimonies of how to do and recovery
Marmara microsurgery is an effective treatment for varicocele. An operation to dress a pathologically dilated vein of testicles is performed through a small incision under local narcosis. This reduces the risk of postoperative complications, allows the patient to recover quickly.
The disease is a varicose vein of the scrotum with malnutrition of the testicles, their heat regulation. This leads to organ atrophy, a decrease or cessation of sperm production, and infertility. Causes of varicocele:
- genetic predisposition
- decrease in the lumen of the veins,
- kidney disease
- increase in abdominal pressure,
- prolonged sexual abstinence,
- sports related to weight lifting,
- wrong lifestyle.
Varicocele is not always treated surgically. At the initial stage, doctors resort to a wait-and-see strategy. The patient is recommended a healthy diet, refusal of alcohol, reduced physical activity. Indications for the treatment of varicocele according to Marmar:
- the occurrence of pain in the scrotum on the background of pathology (including during intercourse, urination),
- primary or secondary infertility in a man,
- adolescent form of the disease,
- pronounced asymmetry of the scrotum, visible swelling of the veins (aesthetic factors).
Contraindications of the Marmara method:
- infectious diseases in the subacute and acute period (including colds, acute respiratory viral infections),
- decompensation of concomitant extragenital, cardiac pathologies,
- bleeding disorders, the use of anticoagulants,
- six months after a stroke or myocardial infarction,
- seasonal allergies.
Pros and cons of Marmar surgery
Advantages of the Marmara Surgical Method:
- high accuracy of manipulations, reduced risk of relapse and complications of the disease,
- small notch and seam size,
- short hospitalization
- reduction in the likelihood of developing infectious processes,
- lack of general anesthesia and related complications.
Disadvantages of the Marmar surgery:
- high cost of the procedure
- the use of local anesthesia, accompanied by pain before and after the intervention,
- high dependence of the quality of treatment on the chosen technique and qualifications of the surgeon.
Before surgical treatment with the Marmara method, to avoid contraindications, the patient undergoes such examinations:
- general urine analysis,
- blood test for syphilis, HIV, hepatitis B and C,
- general and biochemical blood test,
- electrocardiography (ECG),
- blood test to determine the time of coagulation.
Based on the results of the diagnosis, the therapist's conclusion is issued whether the operation can be done.
In infectious processes, somatic diseases, surgery is delayed until the man's health status improves. To prepare for surgery according to the Marmara method, it is recommended to shave the perineum and pubis, refrain from eating food and liquids 12 hours before the procedure.
Stages and techniques for conducting an operation in Marmara
The duration of the procedure is about 40 minutes. Marmara operation with varicocele is carried out according to the scheme:
- The patient is given local anesthesia. To relieve anxiety, sedation is used. In some cases, resort to the use of spinal anesthesia. The patient remains conscious during surgery, but does not experience pain.
- Just below the inguinal ring, the surgeon makes a small incision 2.5-3 cm long. In this area, the spermatic cord is located close to the surface. The skin, fatty tissue, the underlying fascia is dissected. Tissues are bred by mini-retractors, the vessels are pressed, then the doctor drains the wound.
- The muscle that lifts the testicle moves away, a second portion of anesthesia is injected under it.
- The highlighted spermatic cord is fixed on two holders. Manipulation prevents its bending and squeezing.
- The surgeon secretes veins, bandages vessels with a diameter of 2 mm with silk threads, crosses them.
- The surgical field is irrigated with a solution of Papaverine hydrochloride, check for bleeding.
- Conduct a sample of Valsale. The patient is asked to strain, pinch his nose, close his mouth and try to exhale.The test helps determine if the vessels went unnoticed.
- Carry out a check of the surgical field.
- Fabrics are sutured in layers using absorbable suture material. In the case of non-absorbable filaments, the patient is informed about this. A sterile dressing is applied.
After the microsurgical procedure according to Marmar, the patient is issued a sick leave for a period of 7-10 days. This time is necessary for the healing of tissues, compensation of blood circulation in the scrotum.
When non-absorbable sutures are applied, they are removed after 7-10 days. Before this, it is necessary to process the operated area, to conduct dressings.
During the wound healing period after the Marmar procedure, it is recommended:
- limit physical activity, do not lift weights,
- abstain from sex
- wear a suspension (special bandage) if necessary,
- take painkillers in case of discomfort,
- refuse to wear tight or synthetic underwear.
If a man has no problems with the gastrointestinal tract, dietary correction after Marmar intervention is not required. For disorders of the digestive system, you need to eat soft, low-fat food.
Full restoration of the scrotum takes six months.
During this period, a number of recommendations should be observed:
- Avoid excessive loads
- reduce sexual activity,
- avoid overheating,
- refuse to run long distances, ride a bike,
- restrict bathing, visiting a bathhouse, solarium, sauna,
- use a shower for hygiene.
What is varicocele
Varicocele is a varicose vein that is found in the scrotum. The disease does not affect life expectancy and does not threaten the health of men, but it contributes to the development of infertility. This is due to a decrease in sperm motility due to increased blood flow to the testes and an increase in temperature in them.
Due to the expansion of veins and blood flow to the testes, sperm become inactive, therefore infertility develops
What are the advantages of the marmara method?
Urologists believe that Marmar surgery is one of the most reliable methods of therapy. Marmara surgery for varicocele has the following advantages:
- During the operation, it is possible to eliminate varicose veins even on the smallest vessels, which helps to avoid relapse of the disease in the future.
- The technique helps to minimize the risk of injury to surrounding tissues and blood vessels. Complications after surgery are extremely rare and usually minor.
- After treatment with varicocele according to Marmar, a small inconspicuous scar remains.
- The recovery period takes place as soon as possible. A few days after the procedure, the man returns to a full life.
- The Marmara method allows you to increase the qualitative and quantitative indicators of seminal fluid.
The method developed by Professor Marmar has its drawbacks. These include the high cost of the operation.
During surgery, local anesthesia is usually used, so the man is worried about pain.
Good results are observed only with experienced highly qualified specialists in the field of surgery. The effectiveness is also affected by the quality of the equipment used.
Reasons for the development of pathology
Varicocele begins to develop against the background of violation of the walls of blood vessels. They gradually thin out, lose their elasticity and expand due to excessive blood flow.
Valves located in the veins that interfere with the normal flow of blood in the opposite direction “fail” or function, but not well enough.
As a result, there is an increase in pressure veins (for example, when taking a vertical position of the body or as a result of physical stress). Pressure is transmitted in the opposite direction, thereby provoking a gradual expansion in the volumes of the venous vessel. Accordingly, the course of the pathological process in this form leads to the expansion of the veins surrounding the spermatic cord. Most often, pathology is detected even in adolescence at the examination of a urologist. In the first stages, patients rarely feel any signs - this disease can be diagnosed only by palpation or by ultrasound. Most often, varicocele is one-sided, and develops on the left side. If varicose veins are found in two testicles, then this may indicate serious pathologies of the kidneys and their vessels. Varicocele is a serious violation in the functioning of the male reproductive system, accompanied by varicose veins of the testis. Statistics note a significant percentage of detection in men of this pathology - about 30%. Patient complaints about discomfort in the scrotum, as well as a noticeable decrease in one testicle and a decrease in its function, require immediate elimination of the pathological disorder. Marmara surgery for varicocele is recognized as the most sparing option for the correction of pathology. Among its positive characteristics, the absence of negative manifestations is noted, which is the basis for recognizing it as the most effective and reliable method of treating the disease. The opinions of experts are reduced to the fact that surgery using the Marmara method should be performed for all patients who have reached the age of eighteen years if the pathology of the testicles is diagnosed. This condition is accompanied by varicose veins located in the area of the plexiform plexus of the testicle. Among the main signs are noted:
Marmara operation with varicocele and recovery after it
When surgery is needed
Accordingly, the course of the pathological process in this form leads to the expansion of the veins surrounding the spermatic cord.
Most often, pathology is detected even in adolescence at the examination of a urologist. In the first stages, patients rarely feel any signs - this disease can be diagnosed only by palpation or by ultrasound.
Most often, varicocele is one-sided, and develops on the left side. If varicose veins are found in two testicles, then this may indicate serious pathologies of the kidneys and their vessels.
Varicocele is a serious violation in the functioning of the male reproductive system, accompanied by varicose veins of the testis. Statistics note a significant percentage of detection in men of this pathology - about 30%.
Patient complaints about discomfort in the scrotum, as well as a noticeable decrease in one testicle and a decrease in its function, require immediate elimination of the pathological disorder.
Marmara surgery for varicocele is recognized as the most sparing option for the correction of pathology. Among its positive characteristics, the absence of negative manifestations is noted, which is the basis for recognizing it as the most effective and reliable method of treating the disease.
The opinions of experts are reduced to the fact that surgery using the Marmara method should be performed for all patients who have reached the age of eighteen years if the pathology of the testicles is diagnosed.
This condition is accompanied by varicose veins located in the area of the plexiform plexus of the testicle.
Among the main signs are noted:
Is it necessary to have surgery
Surgical treatment is necessary if the patient experiences severe discomfort or has signs of infertility. Older men can do with conservative methods if the disease is not accompanied by clinical manifestations. The operation is no longer relevant with the expansion of the veins of the plexiform plexus, which led to atrophy of the testicle.
Varicocele in a teenager
The left-sided varicocele at the initial stage does not affect the process of sperm formation, therefore, surgical treatment is usually not performed until 18 years of age. The patient is prescribed a conservative treatment of varicose veins.
The postponement of the operation is also justified by the fact that young people are at high risk of recurrence of varicose veins and varicocele against the background of active growth of the sex glands. Under the age of 18 years, postoperative complications can lead to a loss in the functionality of the gonads. An indication for surgery is the rapid development of the disease. It is very important to carry out surgical treatment before the onset of stage 3 varicocele.
How to choose a treatment method for varicocele
The tactics of surgical treatment can be discussed with the doctor only after passing the examination.It is important to correctly identify the cause and degree of the disease, as well as to determine the general condition of the patient and related disorders.
It should be borne in mind that not all surgical departments are equipped enough to perform complex manipulations. In small towns, complex operations can only be accessed in private clinics or not available at all.
The main methods of surgical treatment of varicocele:
- Open intervention according to Ivanissevich. During the operation, the doctor makes a complete cut in the iliac region and bandages the necessary veins. Open access requires dissection of the skin, fiber, tendons and muscles, as well as general anesthesia. After surgery, the patient is waiting for a long recovery.
- Endoscopic surgery. The method involves piercing the abdomen at three points. Instruments and a camera are introduced into small openings so that the surgeon sees the working field. Treatment involves putting a staple on a vein or dressing it. The whole operation takes 20-30 minutes. Despite the fact that the incisions are minimal, the patient will have to recover in the hospital.
- Microsurgical revascularization of the testis. Vein transplant operation.
- Operation Marmara. Gentle intervention, which allows you to cure varicocele at almost any stage.
The Marmara technique is not in vain recognized as the most effective treatment for varicocele. Statistics show that after Marmara surgery in men, reproductive function is much more often restored than when choosing other methods. In many patients, infertility disappears completely.
Benefits of Marmara surgery:
- Fewer relapses compared to other methods.
- Minimal damage to healthy tissues (incision is 1-2 cm in length and 2-4 cm in depth).
- The scar becomes barely noticeable over time. An incision is made in a place that is hidden by pubic hair and linen.
- A microscope is used during the operation, so the surgeon performs all the manipulations very accurately. The integrity of all nerves, arteries and lymph nodes is maintained.
- In one procedure, several different veins can be ligated (internal spermatic, cremaster, inguinal venous collaterals and veins, guiding ligaments).
- Recovery takes 2-3 days. Being in the hospital is optional, after 3-4 hours the patient can return home. Sutures can be removed for 7-8 days, it is possible to use absorbable suture material.
- After Marmara’s surgery, complications such as dropsy and testicular atrophy are less common. The pain syndrome is less pronounced, since the incision is small and the nerve endings are not damaged.
- Minimum postoperative restrictions (during the week you can not expose yourself to physical stress, including having sex).
Before the operation, the doctor prescribes the following standard laboratory and instrumental studies to the patient:
- biochemical blood test,
- general analysis of blood and urine,
- testing for syphilis, hepatitis, HIV infection,
- consultation of an anesthetist.
Methods of diagnostic examination depend on the condition of the patient, age characteristics and the estimated volume of the surgical procedure.
Indications and contraindications for surgery
When diagnosed with varicocele, Marmara surgery is performed in patients over 18 years of age in the following cases:
- A man wants to maintain reproductive functions. Running untreated disease adversely affects the quantity and quality of sperm produced, so the likelihood of conception is reduced.
- The patient is concerned about constant pain in the scrotum. Mild discomfort in the initial stage, as the disease progresses, turns into severe constant pain. This discomfort bothers in everyday life. In this case, a pathologically altered vein is easily palpable.
- In some men, psychological problems arise due to the asymmetry of the scrotum due to the enlargement of one of the testicles. Due to such complexes, the patient has problems in sexual life.
- During walking, the heaviness in the testicles increases, which causes discomfort.
Marmar varicocele surgery is contraindicated in the following cases:
- SARS and other infectious diseases,
- exacerbation of chronic diseases,
- genitourinary tract inflammation,
- if the patient had a heart attack or stroke, then after them the operation is allowed to be done no earlier than six months later.
Important! All contraindications to the operation are temporary, so Marmar surgery is suitable for any man.
Advantages and disadvantages of the Marmara method
Many doctors advise their patients to perform the Marmara operation because of its following advantages:
- the lowest relapse rate for varicocele,
- minimally invasive
- a small cut that will be below the line of linen,
- fast recovery,
- low risk of complications
- short stay in the hospital.
However, as with any other method, the Marmara operation has disadvantages:
- high cost of surgery compared to other types of surgical interventions for varicocele,
- pain during surgery under local anesthesia,
- the success of the procedure depends entirely on the qualifications of the surgeon and the equipment used.
Many experts believe that this technique justifies the costs of its implementation, and the advantages significantly prevail over the disadvantages.
Before the operation, all patients must perform studies, take tests:
- ECG - an electrocardiogram that diagnoses the work of the heart,
- Ultrasound of the testicular veins,
- Ultrasound of the kidneys with dopplerography, performed with bilateral varicocele,
- a blood test for serious infections (HIV, hepatitis, syphilis),
- a coagulogram showing the coagulation rate,
- biochemical and general blood tests,
- Analysis of urine,
The tests are valid for two weeks, so you need to go through all the examinations immediately before the operation.
If patients have any serious, including chronic, diseases, it is required to undergo examination by appropriate specialists. They will conduct specific examinations to make sure there are no contraindications for Marmara surgery. In some cases, the doctor may recommend that the patient stay the night before surgery in a hospital. This is necessary in order to prepare for the operation. In the morning, an ECG and an ultrasound of the veins of the testicles are repeated, the scrotum is shaved and a shower is taken. Before surgery, you can not eat and drink, even water. Before doing an operation for varicocele according to Marmar, the patient must undergo a preparatory examination, which includes the following procedures:
Preparation and progress of the operation
They will conduct specific examinations to make sure there are no contraindications for Marmara surgery.
In some cases, the doctor may recommend that the patient stay the night before surgery in a hospital. This is necessary in order to prepare for the operation. In the morning, an ECG and an ultrasound of the veins of the testicles are repeated, the scrotum is shaved and a shower is taken. Before surgery, you can not eat and drink, even water.
Before doing an operation for varicocele according to Marmar, the patient must undergo a preparatory examination, which includes the following procedures:
In the presence of chronic diseases, consultation with a specialist in these diseases is required. After this, the patient receives permission from the therapist to conduct surgical treatment of varicocele. Self-preparation of a man for the procedure is as follows:
- hygienic shower
- shaving scrotum and groin,
- refusal of food at least 6 hours before surgery (if general anesthesia will be used).
Important! If during the preparation and examination pathologies were identified, which are a temporary contraindication to the procedure, then it is transferred to a more appropriate time when the concomitant diseases are cured.
Marmara operation with varicocele - technique:
- Anesthesia is selected in accordance with the wishes of the patient and taking into account the indications.General anesthesia or local anesthesia is usually used.
- After anesthesia, the surgeon makes an incision in the pathologically dilated veins. Its length is not more than 30 mm.
- Then, the edges of the skin are diluted with a special tool, and another analgesic injection is made under the muscle that fixes the testicle (with general anesthesia this is not necessary). In the treatment of double varicocele, two incisions are made.
- Veins are distinguished from the total vascular bundle, which in diameter reach more than 2 mm. Then they are tied with silk threads.
- Self-absorbable stitches are applied.
After this, the patient is transferred to the ward, where he stays for three days. The length of stay in the hospital is directly related to the patient's condition and the presence of postoperative complications.
Technique and stages of the operation
There are several options for anesthesia that a doctor can advise on the choice of the patient. However, most often the last word is left to the anesthetist:
- Local anesthesia is possible, but not preferred, since the patient will still be disturbed by pain, which can distract the doctor during the operation.
- Epidural anesthesia is extremely rare. This type of anesthesia is effective, but after it complications are possible, such as severe headaches and even a violation of the integrity of nerve endings.
- General anesthesia is the most preferred method of anesthesia for Marmara surgery. The patient falls asleep quickly, the doctor easily controls the depth of sleep. After waking up, a person gradually regains consciousness within an hour, and in rare cases, he may feel nauseous.
After the doctors make sure that the patient has fallen asleep, the surgeon proceeds to the operation:
- The doctor puts on special glasses with magnifying lenses, which help him to perform all actions with great accuracy.
- An additional local anesthesia is performed using an injection and a small incision is made up to three centimeters in length in the area of the inguinal canal.
During the operation of Marmara, a small incision is made, which in the future will be almost invisible
Immediately after surgery, the patient is taken to the ward and allowed to recover. During the first two hours, he is constantly monitored and painkillers are added on demand. Usually, one day should be spent in the ward, and the next one can be discharged if blood tests are in order and in the absence of inflammatory processes.
At home, you will need to adhere to all the recommendations of doctors:
- Reception of antibiotics is necessary in the first days after operation. Most often prescribed drugs such as Cifran.
- To speed up the restoration of veins, phlebotonizing agents (Phlebodia) are indicated.
- Anticoagulants are necessary to prevent the formation of blood clots after surgical interventions (Heparin, Warfarin).
- Every day it is necessary to change the dressing and treat the wound with chlorhexidine.
- Within two weeks, you need to observe sexual rest.
- Two months after surgery, you can not lift weights weighing more than five kilograms.
- It is necessary to refrain from playing sports for three months.
- You can not wet the wound until it is healed. Sutures are removed after a week from the doctor.
- For several months it is worth wearing tightening underwear or a special supportive suspension.
- It is necessary to limit bathing and visiting baths and saunas.
Wearing a suspension makes for faster healing and less discomfort.
How is Marmara surgery done with varicocele?
Marmara surgery, or subingual microsurgical varicocelectomy, is aimed at treating varicocele. The purpose of the surgery is to stop the flow of blood through the dilated venous vessels. To perform the operation, a microscope and special instruments for the microsurgical procedure are required. Removal of varicocele is carried out by a phlebologist-surgeon or urologist.
Checking the reliability of the dressing by:
- vasodilation with a papaverine solution (this also prevents the development of complications such as a violation of the blood supply to the testicle),
- Valsalve test: the patient is asked to strain and try to exhale air by closing his nose and mouth,
- suturing the wound, usually for this I use absorbable suture material, if silk is used, then the patient is informed about this, since in the future he will need to remove the sutures.
Indications for surgery
Subingual microsurgical varicocelectomy is intended exclusively for varicocele, a disease in which the venous vessels of the plexiform plexus expand. The pathological process in some cases may affect the internal spermatic vein. Vascular disease is observed in 15% of the male population. Moreover, in 35% of men, the pathology is characterized by the appearance of primary infertility, in 75-80% it is accompanied by a secondary form of infertility. Because of such statistics, varicocele is called the main cause of infertility in men.
Marmara varicocelectomy is performed with the following indications:
- the presence of a symptomatic picture of the pathology: pain and discomfort in the scrotum,
- the development of oligospermia, characterized by a low sperm count,
- impotence for 2 years or more,
- the inability to have children with a married couple, the etiology of which is unknown and cannot be explained by other reasons.
Varicocelectomy is prescribed for male adolescents with progressive testicular function, if the disease is confirmed by the results of several urological studies.
Medical specialists do not recommend performing surgery in the absence of a symptomatic varicocele card and with a normal spermogram in infertile men.
Unlike other methods of treating the disease, including the Ivanissevich method, the Marmara technology has several of the following advantages:
- Minimal risk of injury: the doctor makes only one incision 1 cm long from the base of the penis. To get to the necessary venous vessel, the surgeon deepens the incision by 2–4 cm.
- Thanks to the microscope, the surgeon can accurately bandage the veins without excising nearby nerve endings, lymph nodes and arterial vessels. After the operation, the patient does not lose sensitivity.
- Low probability of recurrence of venous expansion.
- There is no need to enter the abdominal cavity during surgery. The doctor does not dissect the peritoneum to gain access to the inguinal canal. A medical specialist cuts tissue in layers.
- Recovery after surgery lasts no more than 48 hours. At the same time, the man does not stay in the department longer than 3-4 hours after the operation.
- If necessary, the surgeon during the operation can simultaneously dress both the cremaster and the internal spermatic vein.Possible ligation of the inguinal collaterals and venous vessel of the testicular ligament of the testis without additional surgery.
After tissue repair in the area of operation, scarring scars are practically not visible. Since the incision is made at the exit site of the spermatic cord, the postoperative trail will be under the underwear. This location of the scar allows you to hide cosmetic defects.
During clinical studies, it was found that after microsurgical intervention, reproductive function in men is restored 3-4 times more often than with other surgical methods of treating varicocele.
Sublingual microsurgical varicocelectomy was developed and introduced by Dr. Marmar. Surgical treatment can be carried out under local or general anesthesia, depending on the clinical picture of the pathology. After the onset of anesthesia, the surgeon 1-3 cm cuts the skin in the inguinal region below the inguinal ligament.
The incision must be deepened to reach the spermatic cord, which is brought out. Under it, dilated vessels running along the inguinal canal are located, which the doctor bandages with a microscope. The surgeon stops developing bleeding and returns the spermatic cord to its place. Sutures are applied in layers until the wound is completely closed.
Advantages and disadvantages of treatment
The advantage of this intervention is its effectiveness, low trauma and a small number of complications.
The main disadvantages of the Marmara operation are the high cost and lack of equipment for its implementation in many clinics.
After the operation, you must comply with bed rest. The next day, the patient is allowed to get up and walk carefully over short distances. In the supine position, it is required to do physical exercises for the calf muscles every 60 minutes. Walking and physical activity reduce the risk of thrombosis in the veins of the lower extremities.
In the postoperative period, moderate pain and discomfort may occur. To alleviate the condition, you can perform the following actions:
- ask a doctor to prescribe non-steroidal anti-inflammatory drugs: Ibuprofen, Ketorolac,
- every hour for 20 minutes you can apply ice to the scrotum through tissue gauze folded several times,
- in a horizontal or sitting position, it is necessary to raise the scrotum on a pillow or towel to reduce the level of discomfort and prevent the development of edema (the scrotum must be placed so that it is at the same level with the front surface of the thighs),
- during the first week after surgery, it is recommended to wear a special bandage, which, when walking and exercising, will help reduce discomfort and will support the body.
The sterile dressing must be changed every day. Sutures can be removed after 6-7 days. You can only take a shower 48 hours after the surgical procedure. In this case, you can not direct a stream of water at the wound. During the rehabilitation period, you can not lift weights weighing 5 kg or more, stand for a long time. After a week, light exercise is allowed. You can go to work 3 days after the operation. Sexual life is restored within 1-2 weeks.
Operation Palomo (Palomo) with varicocele: features, technique
Operation Palomo is one of the methods for surgical treatment of varicocele. It is accessible and easy to perform, but traumatic, characterized by a high risk of postoperative complications.
According to the execution technique, it resembles surgical intervention according to the method of Ivanissevich, but after it recurrence of varicocele does not occur so often.
Most often, Palomo surgery is performed in adulthood.
For adolescents and young children, it is prescribed in extreme cases - if there are appropriate indications, the impossibility of using other methods of treatment of varicocele.
After varicocelectomy, 65–70% of men with varicose veins in the scrotum improved sperm count. At the same time, about 60% of patients were able to recover from infertility and conceive a child. Microscopic ligation of the affected veins is most safe among a number of surgical interventions in the treatment of varicocele.
An incision in the groin area avoids dissection of the muscles. As a result, postoperative pain is reduced, the time of surgery and rehabilitation is reduced. Thanks to the microscope, the affected veins can be clearly identified, thereby reducing the risk of relapse. When visualizing the image on a microscope, the surgeon can determine the location of arteries and lymph nodes, therefore, their accidental dressing and mechanical damage are excluded.
The anesthetist and surgeon choose the method of anesthesia depending on the operating equipment, the duration of the operation, and the patient’s overall health status.
|Duration of surgery||Type of anesthesia||Application features||Used anesthetics|
|Up to 60 minutes||Epidural||Anesthetic is administered between 3 and 4 lumbar vertebrae. After the onset of its action, sensitivity below the injection level disappears. Not applicable for high intracranial pressure, severe spinal deformity, aortic stenosis||Tetracaine|
|About half an hour||Local||Anesthetize the place of the future section and the area around it|
|An hour or more||General||Masked||The patient is intubated: the anesthetic enters directly into the trachea. The respiratory system is supported by a ventilator. Not used for bronchial asthma, inflammation of the upper respiratory tract||Nitrous oxide|
|Intravenous||Anesthetic is injected into a vein: the patient is immersed in a deep sleep, but breathes independently||Diprivan|
Operation Palomo is performed under general anesthesia, local anesthesia.
The second method of pain relief is safer, but during surgery with its use, slight discomfort may be felt.
General anesthesia negatively affects the nervous system: its functions are fully restored in a day. Within a few days after its application are possible: nausea, drowsiness and headache.
To reduce edema, prevent the occurrence of bleeding and the formation of hematomas after suturing, a bladder filled with ice is applied to the incision site for 2 hours.
A bandage is put on the scrotum: it prevents the testes from moving when the body position is changed, and prevents the extension of the spermatic cord. It is worn for several days.
From the operating room, the patient is transferred to a ward for observation.
In the first days after Palomo surgery, moderate or severe pain is possible at the site of suturing, the scrotum. To stop the pain, Ketoprofen, Ibuprofen or Dexalgin is prescribed. To prevent the occurrence of complications of an infectious nature within 5 days, the patient is recommended to take antibiotics.
The wound dressing is changed every 2-3 days, the incision site is treated with an antiseptic. If drainage was established during Palomo's surgery, they are removed after a few days.
In the absence of complications, the man is discharged from the hospital after 1-1.5 weeks. On the last day of hospital stay, stitches are removed.
Pros of the technique
Marmara varicocele treatment is a highly effective technology using modern surgical instruments. We consider the main advantages of therapy in more detail.
- The ability to intervene without hospitalization.
- A small neat seam of 2-3 cm will completely hide the hairline.
- Low probability of relapse.
- Fast rehabilitation.
- Minimizing tissue injury, which reduces the risk of bleeding.
- Complete recovery of male fertility.
Marmar surgery is performed using a microscope, which eliminates damage to arteries. Other surgical interventions increase the risk of these injuries by 50%.
Proper nutrition helps to reduce the load on the vessels, accelerate the recovery process after surgery to remove varicocele. During the rehabilitation period, it is recommended to use light, low-calorie dishes:
- Steamed meat and fish.
- Dairy products.
- Porridge on the water.
- Stewed, boiled vegetables and fruits.
Spicy, fatty and spicy foods, sweets, spices and sauces, strong coffee and tea from the diet are best excluded. Drinking alcohol after Palomo surgery is prohibited. It is recommended to limit smoking or stop smoking altogether.
The effectiveness of Marmara surgery with varicocele
Varicocele - this is the name for varicose veins of the scrotum, respectively, only a male can make this diagnosis. Statistics on the prevalence of the disease are represented by varying numbers, on average it can be said - in 30% of men this pathology is detected. If the diagnosis is made, surgery is required to avoid complications.
When varicocele needs to be operated on
Most doctors agree that in all adult men with this diagnosis, the pathology is treated surgically.
Although more and more doctors say that varicocele should be considered more carefully, that not all patients need urgent surgery.
Therefore, it happens that one urologist writes out a patient a referral to a hospital without long conversations, and another recommends waiting. The doctor should always pay attention to the severity of the ailment.
When the operation is indicated to the patient:
- With a bad spermogram (with the condition that the patient plans to become a father),
- With severe soreness in the scrotum (it occurs in the last stages of the disease),
- If the patient wants to be operated on to take care of the aesthetic side of the issue,
- With an uncomfortable feeling of heaviness in the scrotum (discomfort intensifies in the heat and when walking).
Before prescribing surgery for the patient, the doctor must make sure: the patient’s state of health allows him to lie on the surgical table now.
So, for example, you can’t operate a varicocele if a patient has ARVI, if he takes anticoagulants, if he has a pronounced seasonal allergy. During an exacerbation of chronic diseases, surgery should also be postponed.
If the patient suffered a heart attack or stroke, the operation is also delayed for at least six months. After serious treatment of systemic diseases, the body should also be given a rest. In short, the period for the operation should be favorable.
What is the operation of Marmara
This intervention is rightfully considered the most promising today. The number of undesirable consequences is minimal, and complications are predicted in a scanty percentage (if we compare this operation with others).
How should the patient prepare for this operation:
- Take tests for hepatitis, HIV, syphilis. This is a standard set, the examination is carried out for the safety of the patient and the doctor.
- Pass a clinical, biochemical and general blood test.
- Get scheduled fluorography.
- Take a urine test.
- Take an ECG.
If the patient has chronic diseases, then he must undergo specialists who monitor the course of these ailments. Doctors conclude: does the patient have contraindications for surgery. With this conclusion, the man goes to the therapist, the final verdict is behind him.
Before surgery, the patient should shave the scrotum, as well as go to the shower. If an operation is planned under general anesthesia, then the man will have a small consultation with a specialist. They carry out the intervention only on an empty stomach, therefore it is recommended to skip dinner on the evening before the operation.
Description of Marmara’s operation
Anesthesia is a matter of coordination between the patient and the doctor. Anesthesia can be general, local, as well as spinal. Local anesthesia, of course, is preferable: so the patient will recover much faster after the intervention.
The operation of varicocele according to Marmar consists of several stages:
- Landmark - on subingual access for the incision (access under the inguinal ring),
- The surgeon palpates this area, then subcutaneously injects marcain and ice cream, which serve for local analgesic action,
- A doctor in the area of the inguinal canal makes a dissection of the tissues (maximum - up to 3 cm),
- With small retractors, the doctor bends the tissue, dissects the subcutaneous tissue, Scarpa's fascia, also under the muscle that raises the testicle, an injection is made to anesthetize,
- Then the seminal canal stands out, it is displayed in the wound, it is held by two special tools,
- A vein is released, then vessels larger than 2 mm are bandaged (this is done with silk threads),
- The magnifying lenses on the doctor’s eyes allow preserving the operations to maximum accuracy, the threat of the slightest injury to the arteries or nerves is practically zero,
- Doctors also use a Doppler sensor, which, in turn, makes it possible to determine the type of vessel so that only the veins are ligated,
- To avoid vasospasm, the operating area is irrigated with a solution of papaverine hydrochloride (it removes the tone of smooth muscles well),
- Further, the doctor asks the patient to exhale with force with his nose and mouth closed (Valsalva maneuver) - this raises blood pressure, so vessels are detected that go unnoticed.
Varicose veins on the genitals of men
Then, sutures are applied to the fascia (membrane) and skin, usually with self-absorbable sutures. After this, the patient can go to the ward for recovery. Depending on the tactics of the clinic, the condition of the patient, the question is solved when he can go home. In some cases, a man returns home on the day of surgery, but more often hospitalization lasts 2-3 days.
If doctors took non-absorbable suture material, then in a hospital after a certain number of days they will have to come to remove the sutures. This usually happens after 7-10 days, but such situations are not so common.
How is Palomo varicocele removed?
Having retreated 3 cm upwards from the inguinal ring, cut the skin, fatty tissue. Dissect the muscles and move them apart, exposing the testicular vessels. They mobilize the affected seminal vein and artery, bandage them with a ligature and cross. They stop bleeding, dry the wound, suture tissue in layers and apply a sterile dressing.
Pros and Cons of Marmara's Operation
The main advantage of such an intervention as marmar, varicocele surgery is the extremely low risk of complications. Repetitions are also rare, since this operation is characterized by increased accuracy.
Another plus is the inconspicuous seam. The operation is characterized by a small incision, a small probability of infections, as well as a short stay in the hospital.
Intervention does not need general anesthesia, therefore, recovery will be easier.
Methods for treating varicose ulcers
Cons of Marmara’s operation:
- This technology is considered modern, high-tech, and therefore its cost is impressive,
- Local anesthesia is not able to completely remove the pain,
- The technology is such that a lot depends on the professionalism and experience of the doctor.
And although the doctors themselves consider the operation the most modern and effective, a certain percentage of patients note: not only the surgical stage is associated with pain, discomfort may occur for several months to the patient. Not all patients complain of soreness, but some patients claim: during movement, discomfort persists for a long time, physical activity also leads to soreness.
Patients themselves advise those who are still going to undergo this operation in the first month of recovery to exclude sexual contacts. And then, within six months, sexual relations should be allowed no more than once a week.
You can find a recommendation in the first weeks after surgery to take sedatives
Other preparatory stages
Given all the risk factors, specialists in the preparation of the patient resort to the use of such means as:
- Antibacterial or anti-inflammatory drugs that exclude the likelihood of developing an inflammatory process in the area of the problem organ. In this case, the medication is prescribed for 7-10 days and stopped 4-5 days before surgery.
- In order to prevent possible bleeding, heparin low molecular weight drugs are prescribed instead of these drugs.
- The last meal is allowed no later than 10-12 hours before surgery.
- Also, in the evening, you should carefully shave the area undergoing surgery.
An obligatory component of the preparatory phase is the conclusion of narrow specialists on permission to conduct an operation if chronic diseases occur.
What is the Marmara technique
After an improperly performed operation, the patient may suffer from prolonged pain, swelling, dropsy, infection or bleeding.
Marmara Operation Stages:
- Regardless of the location of the damaged veins, the operation is performed through subingual access (incision under the inguinal ring). The intervention area is additionally anesthetized with marcaine or lidocaine.
- The surgeon makes an incision of 2-3 cm, dissects all layers of the skin and fixes them with a retractor. Under the muscle that tightens the testicle, another injection of pain medication is given.
- The doctor puts the spermatic cord into the wound for a better view. The cord is fixed, providing protection against accidental damage and clamping.
- Using a microscope, or rather a magnifying lens, identify all damaged veins and dress them with silk threads. Using a microscope allows you to maintain the integrity of nerves and blood vessels, which reduces the risk of postoperative complications. The doctor can also use a Doppler sensor to isolate the veins.
- To prevent vasospasm, the intervention area is irrigated with a papaverine solution. The tool removes the tone of smooth muscles and dilates blood vessels.
- The surgeon may ask the patient to exhale with his mouth and nose closed. So missing vessels are detected, which reduces the risk of varicocele recurrence.
- At the end of the operation, the doctor sets up a drain and heals the wound. Absorbable sutures are commonly used.
Recovery after Marmara surgery
The recovery period after Marmara surgery is the fastest and easiest among all types of surgical intervention for varicocele. In the early days, you need to do dressings that the patient can easily carry out at home. A man can immediately return to his lifestyle, just a week giving up sports and intimacy.
If a man does not feel discomfort, sexual activity can be restored 2 weeks after surgery. The number of sexual contacts should be reduced to one per week (for a period of up to a month). When after surgery there are difficulties with the implementation of sexual intercourse, you need to see a doctor. This can be an alarming symptom, because surgery does not affect sexual function.
Complete restoration of internal structures occurs in 6 months. During this period, it is not recommended to overheat and injure the area of the scrotum. To avoid this, you need to refuse to take hot baths, bike rides and long-distance running, as well as excessive sexual activity. A visit to the bathhouse, sauna or solarium is undesirable.
Professional athletes should understand that it will be possible to return to standard training only after six months. Sometimes recovery after Marmara surgery takes 9 months, but this is due to the characteristics of the body and the degree of varicocele in a particular patient.
Types of Anesthesia
When choosing an anesthesia method, the wishes of the patient are taken into account. However, preference is given to the method, which is the most appropriate according to its condition:
- General anesthesia allows the operation to be performed in the patient’s sleep state. The latter comes to consciousness after completing the manipulation of the surgeon.
- Spinal anesthesia affects only the lower body. Anesthetic injection is injected into the spine.
- Local anesthesia involves anesthesia only in the invasive zone.
Doctors prefer the latter method. It is more easily tolerated by the body..
Midazolam hydrochloride (antiepileptic agent) and Fentanyl citrate (potent analgesic drug) are administered intravenously to the patient.
Complications and relapse
Despite the fact that the Marmara technique reduces the number of complications, there can still be negative consequences. Early complications include bleeding, wound infection, damage to testicular arteries and trauma to the spermatic cord. After surgery, the patient may begin to be allergic to suture material, which is easy to stop with antihistamines.
Anxiety symptoms after surgery:
- temperature above 38 °
- severe enlargement and soreness of the scrotum,
- scrotum color change
- pus discharge
- divergence of the edges of the cut,
- loss of skin sensitivity in and around the intervention area.
Even if a man has only one of the listed symptoms, it is urgent to notify the doctor about this. Even the slightest discomfort can be a sign of an ongoing complication.
The main reasons for the re-development of varicocele:
- erroneous diagnosis (the doctor revealed not all damaged vessels),
- technical errors during the operation,
- early surgical intervention (treatment of varicocele during the puberty is undesirable, since the gonads are still actively developing).
The risk of varicocele recurrence is 90% dependent on the correctness of the operation. An inexperienced doctor can damage the lymphatic vessels during the operation and provoke dropsy of the testicle, as well as damage the testicular arteries, disrupting trophic and blood supply. The latter leads to testicular atrophy.
The incision is performed in the subingual zone (the area of the inguinal ring). It is detected by palpation. Markain and Lidocaine are used subcutaneously here, used to enhance the analgesic effect.
The Marmara method involves the use of such stages of the operation technique as:
- Dissection of tissue in the sub-inguinal ring. The incision is not more than 3 cm. Subsequently, such a small postoperative suture, covered with hair, is completely invisible.
- The next step is the removal of the spermatic cord. It is fixed at the edge of the open wound to avoid damage.
- Then the veins of the testicle are secreted, large vessels are ligated. The technique of the operation involves the use of special lenses, which greatly increases the accuracy of the surgeon's manipulations and eliminates the likelihood of injury to arteries and nerves.
- The invasive area is treated with a solution of Papaverine hydrochloride, which helps to eliminate cramping in smooth muscles.
- The final stage of the procedure is the establishment of a drainage graduate.
The operation takes no more than 35 minutes, after which the patient is taken to the ward. Given the condition and desire of the patient, he is discharged home after 4-5 hours after surgery. Sometimes hospitalization lasts 2-3 days.
To avoid unpleasant and dangerous complications, you need to choose a good clinic and an experienced surgeon. After the operation, you must follow all the recommendations of the andrologist.
How to prevent complications after surgery:
- It is important to protect the scrotum from damage, overheating and overvoltage.
- Wound infection is possible, so dressings should be done only with clean hands and sterile medical supplies.
- It is advisable to follow a balanced diet with vitamins and minerals. Maintaining normal gastrointestinal tract function favorably affects intra-abdominal pressure.
- It is necessary to visit a doctor according to the schedule prescribed by a specialist.
- When the recovery period ends, you need to exercise daily physical activity. This will avoid stagnation of blood in the pelvis. If a man has sedentary work, you need to perform special exercises.
In the case of varicocele, you can not rely on folk remedies and conservative therapy. Most scrotal vein patients need surgical treatment. Modern medicine offers the Marmara method to eliminate varicocele, which guarantees complete recovery and the absence of complications.
How long does rehabilitation take?
Full restoration of the scrotum occurs within 6-7 months. At this time, you must adhere to some restrictive rules:
- Do not overload the body with physical and sexual activity. It should be noted that the first intimate contacts may be accompanied by pain that disappears over time.
- Avoid overheating.
- Exclude such loads as running, cycling. Active sports are possible no earlier than 6-9 months after surgery.
- Refuse to visit the sauna, solarium and long rest in the bathroom. Shower and swimming in the pool will not harm.
Compliance with these rules will greatly accelerate the recovery process. In the absence of complications, after 6 months the veins of the scrotum of the testicle cease to be felt, which indicates a complete recovery.
There is a likelihood of a longer rehabilitation - up to 9-10 months.
Features of Marmara's operation with varicocele
Treatment of varicocele according to marmara is attributed to the gold standards of therapy for this pathology. Until microsurgery was sufficiently developed, other operations for varicocele therapy provoked the development of serious complications in the form of testicular atrophy and the development of dropsy.
Marmara surgery for varicocele refers to the microsurgical method of treating pathology. The operation with varicocele is carried out using a small microscope. This helps to reduce the repeated risk of developing varicocele and the likelihood of developing serious complications.
The essence of the operation Ivanissevich with varicocele
The essence of this intervention is the ligation of blood vessels to block retrograde blood flow through the veins of the testicle. Today, such an operation is performed less and less, since in many respects it is inferior to minimally invasive and endoscopic techniques.
The main disadvantage of Ivanissevich’s surgery is the high relapse rate. About a quarter of the operated men again face this ailment.
It is possible to perform surgery under local anesthesia, but not for all patients such a wish would be reasonable. So, emotionally labile men and children are still recommended general anesthesia.
This operation includes three main points:
- Section of the abdominal wall,
- Isolation of the testicular vein, its ligation, intersection,
- Control of hemostasis, suturing the incision.
After surgical operations, the patient stays in a hospital for at least a week. Only after 8-10 days later will the stitches be removed. Rehabilitation usually takes several weeks.
About six months, soreness in the suture and groin may persist: the patients themselves are concerned about these symptoms, but doctors say that such phenomena are considered normal for the first postoperative months.
The recovery process depends on whether the man complies with all the recommendations.
Can teenagers do it?
With a high risk of impaired fertility, intense pain in the testicles, reduced testicle size, Palomo surgery can be performed in adolescence. It is not recommended to resort to surgical treatment of varicocele in the first stages of its development, in the absence of symptoms: this threatens the underdevelopment of the testicles, the re-development of pathology of the testicular veins in the future.
Varicocele is a male disease, which is one of the factors of infertility. And this is due to the fact that in the testicle with such a defect, the temperature is above normal.
It approaches the total body temperature, and for healthy sperm production, the temperature should be slightly lower.
Also, with varicocele, oxygen starvation of the testicle is fixed, and in its tissue, in addition, free radicals can accumulate, which damage these same tissues. If you do not operate on time, the problem of male infertility can become intractable.
The choice of a way to eliminate the problem depends not only on the medical decision: the patient’s readiness for surgery is also important.
Sometimes you have to consult not only with a urologist from the clinic, but also with another specialist. Do not worry: rare operations lead to complications. The problem needs to be resolved unequivocally, and you should not put off these cardinal actions in a long box.
When can I begin to conceive a child after surgery Palomo?
If the rehabilitation period proceeds well, without complications, you can start conceiving a child six months after Palomo's operation. But it is best to plan the birth of a child a year after the intervention.
At the end of this period, sperm and seminal fluid from a functional point of view will be better.
Before a planned pregnancy, a man and a woman are advised to consult a specialist and undergo an examination prescribed by a doctor.