Ivanissevich operation with varicocele
Ivanissevich's operation (OI) for varicose veins of the spermatic cord (varicocele) is considered one of the main types of surgical care for this pathology. She consists in ligation of blood vessels to eliminate retrograde blood flow through the veins of the testicle.
Modern surgery has many methods for treating varicose veins of the testicular vein and its branches. Minimally invasive and endoscopic methods have been proposed, but Ivanissevich’s operation continues to remain popular, although it has been performed less frequently.
Testicular vein ligation was proposed by Ivanissevich at the beginning of the last century, the method had many shortcomings and gave a high relapse rate. In addition, this is one of the most traumatic operations with varicocele. At the same time, relative simplicity and effectiveness make the operation to cross the testicular vein one of the most affordable techniques for a wide range of patients.
The main disadvantage of the method is the high relapse rate. Among adult men, up to a quarter of the operated patients again encounter the problem of varicocele, in pediatric practice this figure reaches 40% or more, which is associated with the continued growth and formation of the vascular system as the child grows older.
The undoubted advantage of the Ivanissevich operation can be considered a direct effect on the pathogenetic mechanisms of pathology,that is, through the intervention, the varicocele substrate itself, the testicular vein, is eliminated. Microsurgical technique and optical equipment allow to increase the efficiency of the procedure.
Indications and contraindications for the operation of Ivanissevich
OI is performed both for adult men and for children and adolescents. The only indication for it is varicose testicular veins of any severity,but the feasibility and duration of treatment are determined individually.
Opinions regarding exactly when it is necessary to operate a varicocele disagree. Some surgeons believe that treatment should not be delayed, since varicose veins cause infertility. Other andrologists, not without reason, point to the lack of infertility in many patients with varicocele, and also that spermograms do not always improve after the intervention, which means that there is no urgency in the surgical treatment of pathology.
Contraindications for surgery Ivanissevich with varicocele is also there. Among them:
- Severe decompensated pathology of internal organs,
- Acute infectious diseases
- Changes in the skin of a purulent-inflammatory nature, especially in the place where the incision will be made,
- Genitourinary infection
- Pathology of blood coagulation.
Diseases of the internal organs before the planned intervention should, if possible, be treated or transferred to a stable course. Infectious pathology and skin damage will be an obstacle until they are completely eliminated.
Preparation and progress of the operation Ivanissevich
Preoperative preparation is not much different from that in other operations. The patient to undergo a diagnosis and clarify the nature of the changes will go through a variety of surveys - take blood and urine tests, undergo an ultrasound of the scrotum with a doppler, a spermogram and a study of sex hormones.
The list of procedures necessarily includes a coagulogram, an HIV test, hepatitis, syphilis, and genital infections. With the planned general anesthesia, the blood group and Rh factor are determined, fluorography, ECG are prescribed.
If the patient, in addition to varicose veins, does not suffer from any other chronic diseases, then only an examination by a urologist (andrologist), an anesthesiologist’s consultation and a therapist’s conclusion on the safety of the proposed treatment are prescribed. In the case of concomitant pathology, consultations of narrow specialists are shown - a cardiologist, endocrinologist, nephrologist, etc.
Ivanissevich’s operation is usually performed under local anesthesia,but it is advisable for children and emotionally labile patients to use general anesthesia when the patient is sleeping, does not feel anything, and does not remember the events in the operating room.
It is necessary to come to the hospital at the appointed time with the results of all the examinations passed. On the eve of the operation, in the evening, the patient takes a shower, shaves the hair on his stomach and groin and changes clothes. Last meal - no later than 22 hours. At night, a tranquilizer may be administered or a mild hypnotic may be prescribed.
The progress of the operation includes several stages:
- Section of the abdominal wall,
- Isolation of the testicular vein, its ligation and intersection,
- Checking hemostasis and suturing wounds.
OI is performed when the patient is lying on his back. After the local anesthetic (novocaine) begins to act or the patient plunges into general anesthesia, the surgeon treats the place of the upcoming incision with an antiseptic, then dissects the skin and subcutaneous tissue in the transverse-oblique direction in the projection of the inguinal canal, at the level of the anterior superior iliac spine. The incision resembles that of appendicitis, its length is about 5 cm.
Muscle aponeurosis is cut, and the muscle fibers themselves are moved apart. By moving the outer sheet of the peritoneum to the center of the abdomen, the surgeon searches for the vascular plexus, secrete a testicular vein in it, fixes it with clamps and crosses it.
It happens that not one large vein, but several at once leaves the inguinal canal, and if all collaterals are not bandaged, a relapse is inevitable. To prevent the return of pathology, the surgeon carefully examines the exit zone from the inguinal canal of venous vessels and bandages all visible large branches.
With varicocele in the cluster-like plexus of the scrotum, a significant amount of blood accumulates, and in order to accelerate its evacuation, vasodilation and rapid resolution of varicose veins, the surgeon massages the scrotum tissue, while the distal end of the testicular vein is already expanded with a clamp in the other hand.
Blood flowing from the veins is removed, the wound is washed, the vessels are ligated or coagulated. After careful hemostasis, soft tissues are sutured, and drainages can be left in the wound. The seam is covered with a sterile dressing. The operation lasts no more than half an hour.
Testicular vein ligation interventions are considered safe, but some may still occur. complications. One of the most dangerous is the ligation of the iliac artery, which can happen by accident, by mistake of the surgeon if he takes it for a vein, or during a long search for venous branches, when there is a risk of injury to the artery with instruments.
Unpleasant, although not life-threatening, the result of the operation may be the ligation of the nerve going through the inguinal canal. It can be captured accidentally with the vessel or damaged by instruments during prolonged manipulation of the venous plexus. In response to damage to this nerve, sensitivity from the inside of the thigh is impaired, and pain is also likely.
The essence of the method
Ivanissevich’s technique involves conventional abdominal varicocelectomy, in which an incision is made in the groin area
Ivanissevich's operation is a classic type of surgical intervention that helps get rid of varicocele in men. The essence of the method will be in the ligation of blood vessels to normalize blood circulation in the scrotum.
Ivanissevich’s technique involves the usual abdominal varicocelectomy, in which an incision is made in the groin area. Because of this, the rehabilitation period of the patient increases. Currently, medicine offers endoscopic methods of therapy that do not imply the performance of incisions. But, despite this, the operation of Ivanissevich is still used by doctors.
Advantages and disadvantages of surgery
Ivanissevich’s methodology has its positive and negative points. The advantages of surgery are as follows:
- Low cost of operation.
- No need for special equipment.
- A simple technique that does not require special knowledge.
- The ability to carry out at any stage of varicocele and at any age of the patient.
Unfortunately, Ivanissevich’s surgery has more drawbacks compared to other surgical methods than advantages. The negative aspects of treatment include the following:
- High degree of trauma.
- A high risk of complications after surgery and the re-development of pathology.
- Long term rehabilitation.
- The presence of postoperative pain.
- The appearance of a large scar at the site of the incision.
Modern methods of surgery, which replaced the abdominal surgery, have much more advantages and fewer minuses. But, despite this, doctors still apply the Ivanissevich method.
Varicocele treatment in Moscow
Clinical Center for Microsurgery RRA on the basis of the Federal State Institution Medical and Rehabilitation Center of the Ministry of Health and Social Development of the Russian Federation - operations for varicocele:
- Operations under the guidance of a well-known microsurgeon-andrologist, MD professor M. Sokolshchik
- All types of surgical treatment for varicocele
- Extensive experience in conducting unique microsurgical operations for varicocele
Appointment for consultation and surgery in the andrology department of the Federal State Institution LRC of the Ministry of Health and Social Development of the Russian Federation - 8 (495) 66-44-888
Operation Palomo (Palomo) is close in meaning to the technique of Ivanissevich (Ivanissevich). They differ only in the fact that Palomo suggested making an incision above the inguinal canal, where the testicular vein, as a rule, is already coming out of the plexus and ligating the testicular artery together with the testicular vein. Further actions of the surgeon, in fact, are no different from those during the operation of Ivanissevich.
Thus, it turns out that there are no fundamental differences between these approaches, but, due to somewhat more free and more open access to the testicular vein, using the Palomo technique, the risk of developing varicocele relapse is somewhat reduced, that is, technical errors associated with undetected additional branches testicular veins. However, in spite of this, even here, it is not possible to isolate all the collectors of a possible pathological venous outflow, and therefore the relapse rate on average reaches 25%.
The main drawback of the Palomo technique is that, in order to minimize the likelihood of a relapse, the internal seminal (testicular) artery is also ligated during the operation, which reduces the flow of arterial blood to the testicle. This artery has a very small diameter (approximately 0.5-1 mm), and therefore it can sometimes be very, very difficult to maintain. Damage to it often later turns into testicular atrophy.
Palomo himself was convinced that this blood vessel can be crossed without any risk of such problems, and only in situations where the arteries of the vas deferens duct intersect simultaneously with the internal seminal artery, there is a risk of testicular atrophy
In addition, stealth often causes damage to thin and almost transparent lymphatic vessels. In this regard, after treatment of varicocele in children, as well as in adults with Palomo surgery, often (with a frequency of up to 7%) another complication of hydrocele (dropsy of the testicle) associated with impaired lymphatic outflow is formed.
This gave an impetus to the creation of a modification of the Palomo-Erokhin operation (1979), when in the process of surgical intervention, special contrasting of the lymphatic vessels of the testicle is used in order to avoid their trauma during the manipulations.
On average, Palomo’s operation takes no more than twenty-five to thirty minutes. Like Ivanissevich’s methodology, it was quite common until 2000. It was believed that this surgical intervention gives a good cosmetic result and almost does not adversely affect the quality of the patient's future life. Now, some experts are sure that the approach developed by Palomo is not physiological and does more harm than good, namely: it leads to more pronounced and serious circulatory disorders than the presence of untreated varicocele in itself. In addition, currently new methods are being introduced into clinical practice that promise to provide higher results with lower morbidity.
(495) 506-61-01 - surgical andrology reference
After the operation, an ice compress is applied to the incision site.
Ivanissevich’s operation with varicocele is quite simple. The main thing for the surgeon is to prevent accidental damage to blood vessels. Otherwise, the risk of complications increases.
When performing surgical treatment, the doctor performs the following sequential actions:
- Introduces an anesthetic. The operation is performed using local anesthesia. Usually used novocaine. If the patient has a contraindication to the pain medication, then general anesthesia is prescribed.
- Cuts longitudinally the iliac region. The size of the incision is not more than 5 cm. When performing it, it is important not to contact the vessels.
- Checks the condition of the veins. Particularly carefully required to evaluate blood vessels in the late stages of varicocele, in which several branches are affected immediately.
- It detects affected veins, fixes them using special threads, after which it stitches and dissects. With this action, it is important that the blood does not get to the place of cutting the vessel.
- It removes a large accumulation of blood in the plexiform plexus by massage of the scrotum tissue. When massaging, the lumen of the end of the vein of the scrotum leaves widened with a special clamp.
- Sutures. This is done in layers. After suturing, the wound is treated with an antiseptic and covered with a sterile gauze dressing.
After surgery, doctors advise applying an ice pack to the incision site. This helps eliminate swelling of the joints. To prevent inflammatory processes, the doctor can prescribe antibiotics, and with the development of pain, pain medications.
Preparation for the operation
Before the operation, you need to diagnose
Before the operation of Ivanissevich, the patient needs to be examined. This is necessary in order to identify possible contraindications for surgical treatment, to assess the general condition of the man and confirm the presence of a certain stage of varicocele.
Diagnostics includes the following methods:
- Blood test for general and biochemical parameters.
- A blood test to determine the group and Rh factor.
- Blood coagulation test.
- A blood test for HIV infection.
- General urine analysis.
- Bacterial culture of urine.
- Ultrasound examination of the testicles.
If during the examination no contraindications are revealed, the attending physician will develop a treatment plan.
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An operation according to the Ivanissevich method for varicocele has one indication - varicose veins of the testicle. Usually, an intervention is prescribed for the third or fourth degree of a male disease, when a pronounced clinical picture is observed.
A surgery is required if the following symptoms are present:
- Deterioration of sperm quality.
- Severe pain in the groin.
- Testicular growth arrest in a teenager during puberty.
- The presence of a pronounced cosmetic defect.
The expediency of surgical treatment is determined by the attending doctor based on the results of the examination.
It is necessary to cure pathological processes in the body, only then do the operation
The Ivanissevich method has its contraindications. These include the following:
- Severe diseases of the internal organs in a decompensated stage.
- The acute form of infectious pathologies.
- Skin diseases, accompanied by discharge of pus, the development of inflammation. This is especially true for the skin located at the site of the planned incision.
- Infectious diseases of the urinary and reproductive system.
- Poor blood coagulation.
If possible, pathological processes in the body are cured, only then surgery is prescribed. Particularly dangerous with the intervention of infection, therefore, they must be eliminated in full.
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Risk of complications during surgery
In the process of surgical intervention, there is always a risk of adverse effects. They are usually associated with accidental damage to healthy tissues. The most common complications during surgical treatment are:
- Iliac artery injury. This consequence is considered the most dangerous. Such an artery is located next to the inguinal vein, so the doctor may incorrectly bandage it. It is also possible just accidental damage with surgical instruments.
- Damage to the vessels of the lymphatic system. As a result, the patient after surgery has a hydrocele.
- Damage to nerve endings. This complication is not dangerous, but it brings strong pain. Also, the affected nerve causes a temporary loss of sensation in the thigh areas.
No one is safe from mistakes during the operation. If after treatment unpleasant symptoms occur, you should immediately consult a doctor to timely identify complications.
Features of the disease
Varicocele is a disease associated with damage to the veins in the testicle (usually the left) and spermatic cord. When blood flows, the valves of the vessels function incorrectly, the blood flow is disturbed, causing bloating of the veins, pain and an unpleasant feeling of fullness in the testicle.
At the initial stage, you can see a more pronounced venous network under the skin. With the development of the disease, veins appear more prominently, standing out sharply against the background of another testicle, not affected by the disease.
Over time, the scrotum may sag, the affected testicle will decrease in size, which greatly worries patients. The most serious complication of the disease is infertility.
If varicocele is suspected, the patient passes a spermogram.
However, some experts believe that conservative therapy is not so much a treatment as a delay in the inevitable surgical intervention.
Only a varicocelectomy will help fix the defect. This procedure does not require urgency. The doctor has the opportunity to observe the development of the disease, evaluate its dynamics and offer the patient the best solution to the problem.
A planned operation takes place in a calm environment, complications occur much less frequently.
Rehabilitation after surgery
For a full recovery, a man will need from 3 months to six months
After the end of the surgical intervention, the patient is put on a scrotum of suspensoria. It is a kind of bandage that prevents stretching of the spermatic cord, does not allow the testicle to move when walking.
For 8-10 days, the man is in stationary conditions. At this time, the attending physician monitors the patient's recovery. Stitches are removed before discharge. If no complications were found while in the hospital, the patient is allowed to go home.
At home, rehabilitation continues. For a full recovery, a man will need from 3 months to six months. The entire postoperative period, the patient must strictly adhere to the recommendations of doctors.
The doctor advises the following:
- Refuse to visit the sauna or bath, taking a bath with hot water.
- Wear tight underwear.
- Refrain from intimate life.
- Avoid intense physical activity.
- Do not lift weights.
- Follow the hygiene of the seams.
These recommendations will help minimize the risk of adverse effects after surgical treatment.
The likelihood of complications after surgery with varicocele is always there. But, as a rule, they rarely occur. Application of the Ivanissevich method can cause the following consequences:
- The appearance of a hematoma at the site of the incision.
- Dropsy. Pathology is the accumulation of a large amount of lymph in the abdominal cavity. Typically, this phenomenon is due to the fact that the doctor mistakenly bandages the lymphatic vessel with the blood vessel.
- Painful sensations. A symptom develops as a result of a stretched testicular capsule of the testis or accidental damage to the nerve root in the groin area.
- Testicular atrophy. Under this condition is understood the violation of the functions of the sex gland and a decrease in its parameters.
- Penetration of infection into the postoperative wound. In this case, the patient develops an elevated body temperature, the appearance of purulent masses, and his state of health sharply worsens.
After surgery, there is always a risk of varicocele recurrence, especially if it was performed in the last stages of the disease.
Analogs of operation
A good alternative to surgery according to the Ivanissevich method is laparoscopy
There are two types of abdominal surgery that are very similar in principle to the Ivanissevich method. These include the following operations:
- Palomo In the process of surgery, an incision is made in the peritoneum, through which the affected veins and artery are bandaged. At the same time, a different source of blood flow should remain in the testicles so that the blood circulation process is not disturbed.
- Bernardi. The essence of therapy is to ligate the testicular vein in the area of the internal inguinal ring. The artery is not affected.
A good alternative to surgery according to the Ivanissevich method is laparoscopy. It does not involve incisions, so the recovery time after treatment is significantly reduced.
Laparoscopic intervention is performed as follows. Three punctures are made in the abdomen. Through the first, a video camera is introduced, and through the remaining surgical instruments. First, air is released into the abdominal cavity so that the organs move apart and do not interfere with access to the affected veins.
The image of all the manipulations performed during the operation is displayed on the monitor. During therapy, the doctor excises 3 cm of the dilated vein, and compresses its ends with the help of special devices. After that, the tools are removed and stitches are applied.
Thus, the operation according to Ivanissevich with varicocele is a classic way to eliminate dilated veins, which has its pros and cons. Currently, with the possibility of using endoscopic therapy, this method is relegated to the background.
Modern urology offers a wide range of varicocelectomy options. The choice of this or that intervention depends on the age of the patient, the stage of the disease, the individual characteristics of the body and the opinion of the attending physician.
Most often, the patient is offered occlusive surgery. Their essence is the ligation of the vein supplying the affected testicle, and the normalization of blood flow. This category includes surgery on varicocele according to Ivanissevich, Palomo, Marmara, laparoscopic varicocelectomy, non-surgical interventions (coagulation, sclerotherapy), microsurgical procedures.
The delicate issue is the cost of varicocelectomy. The most expensive options are microsurgery and endovascular embolization. They are made at different stages of the disease, relapses and complications are rare. However, not every surgeon is able to perform such an intervention; many clinics do not even include them in the price list.
Usually in clinics, the operation according to Ivanisevich is put on stream, which guarantees the quality work of the surgeon and reduces the risk of complications.
Classical varicocelectomy can be done without a policy, its price is affordable for most patients. The price includes anesthesia and a hospital bed.
Ivanissevich’s operation for varicocele: what is its essence?
Ivanissevich's operation is performed in most Russian clinics. Requires hospitalization, performed under general or spinal anesthesia. Only general anesthesia is suitable for children and adolescents.
Success depends on the skill of the surgeon, the incision is made in the inguinal fold, after which the enlarged testicular vein is stitched and pulled.
The wound is sutured, a sterile dressing is applied to it. Recovery lasts up to 2 weeks, with complications, the rehabilitation period lengthens.
Ivanissevich intervention variation - Operation Palomo with varicocele. The main difference is the location of the cut.
- An exception may be a loose vein type, in which case the surgeon has to bandage all the vessels separately.
- The operation is carried out in a hospital, anesthesia can be general or local.
- Compared with the Ivanissevich procedure, the risk of complications is reducedsince the vein is in a place where there are no large vessels and nerves.
- Recovery takes 2 weeks, in some cases it is extended to 1 month.
Postoperative period: limitations and features
Classic treatmentsinvolving cuts require long recovery in 3-4 weeks. Ivanissevich’s operation is no exception.
The healing process depends on the individual characteristics of the body. Once every 2-3 days, the sterile dressing changes on the wound, the patient receives a course of antibiotics to prevent inflammation. In case of pain attacks, the patient is given anesthetics in the form of tablets.
During the recovery period, the patient should wear a suspension that keeps the scrotum in a comfortable position. Sutures are removed on day 9.
The surgeon examines the scrotum and testicles, performs palpation, making sure that the healing process is proceeding correctly. In the future, the patient is recommended to visit the urologist 2 times a year, in case of suspicion of relapse, a spermogram is prescribed.
During the rehabilitation period, hot baths and a bath are prohibitedHygiene procedures are limited to a warm shower. It is necessary to reduce physical activity, not to lift weights and not to strain the muscles of the press. During recovery, it is not recommended to have sex, after the end of the postoperative period this restriction is removed.
How to avoid relapse?
Most often relapses occur in patients with branching veins. If the surgeon does not notice one of the branches and does not pull it, the blood flow in the affected vein will not stop.
The vessel will continue to function, pressure drops will provoke expansion of the veins and the disease will begin to develop again. In this case, a second operation is scheduled. A minimally invasive technique is usually practiced with minimal risk of relapse. Cutting in the inguinal region is not recommended a second time.
Relapse can provoke an improper lifestyle. The patient is recommended moderate physical activity, a balanced diet, quitting smoking and alcohol.
Ivanissevich’s operation and its variant Palomo’s operation with varicocele is a quick and quite effective treatment. With a reasonable lifestyle and skill of the surgeon, the patient manages to avoid relapses and complications, to fully restore health and performance.
Postoperative period and complications
As soon as the operation is completed, a suspensory is put on the scrotum - a kind of bandage that prevents the extension of the spermatic cord and the movement of the testicle when taking a vertical position of the body. From the operating room, the patient is taken to the ward for further observation.
In the first few days, pain in the seam area, which is stopped with the help of analgesics, may disturb. To prevent infectious complications, antibiotics are necessarily prescribed for the next five days. The day after the intervention, the dressing is replaced, the drainage is removed after a couple of days.
In the postoperative period, the operated patient is in the hospital under observation for up to 8-10 days. By the end of this period, skin sutures are removed. With a favorable course of the recovery phase and the absence of complications, the patient can be released home after a few days for observation by the surgeon of the clinic.
Rehabilitation after Ivanissevich’s operation may take several weeks, and finally it will be possible to judge its effectiveness after 3-6 months. During the entire recovery period, the patient should completely exclude visiting a sauna or bath, taking hot baths and other conditions in which the scrotum may overheat.
- For the prevention of complications and relapse, one should not wear tight tight-fitting underwear and clothes for the first few weeks; one should give up sex and time.
- The first six months after the operation, intensive physical training and active sports are not recommended at all, you should abandon weight lifting and training in the gym, coupled with a load on the front abdominal wall.
- After the operation of Ivanissevich, complications are possible, although they are relatively rare:
- Purulent-inflammatory changes from the side of the surgical wound,
- Testicular dropsy - is relatively common
- Testicular atrophy - occurs with ligation of the aichic artery and leads to persistent infertility.
One of the most frequent consequences of surgical treatment of varicocele is considered a relapse of the pathology. According to various sources, its probability reaches 40%, but modern microsurgical technique, a thorough examination and search of all branches and collaterals of the venous plexus with their dressing can significantly reduce the risk of pathology return.
To prevent infectious complications, antibiotics are prescribed, the dressing is changed regularly, and the patient is advised not to wet it and inform the doctor about any suspicious changes in the suture.
Ivanissevich’s operation is performed in ordinary surgical or urological departments, in most cases - for free, according to the compulsory medical insurance system. Patients who wish to receive treatment at paid centers can also apply there. On average, the cost of an operation to cross the testicular vein is about 20 thousand rubles.
Those men who are planning an operation, or their relatives, want to know the reviews of already operated patients, not only about specific clinics or specialists, but also about the course of the recovery period and the effectiveness of the procedure.
Most men who have undergone the intervention, on the one hand, note its effectiveness, on the other hand, they complain of pain in the groin during straining, physical effort, sexual intercourse, heaviness and pain in the scrotum. Doctors in such cases advise against panic - severity and some pain often accompany the recovery period and disappear after a few months.
With the appearance of new varicose veins, feelings of heaviness and pain after six months or more after the operation, a relapse of the pathology can be suspected, in which it is necessary to visit a urologist to resolve the issue of repeated intervention.
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.
Preparation for surgery
The preparation for surgery according to the Palomo technique is the same as during the operation of Ivanissevich. 1-2 weeks before it is carried out, in order to exclude the presence of contraindications and assess the state of health in general, the patient is recommended to undergo a comprehensive examination. It includes:
- Analysis of urine.
- General, detailed blood test.
- Ultrasound scrotum.
- X-ray of the lungs.
- Blood coagulation test.
- The study of hormonal background.
- Tests for the detection of HIV infection, sexually transmitted diseases and hepatitis C, B.
If during the examination no other pathologies are revealed, consultation of an anesthesiologist, surgeon, urologist is indicated. In the presence of concomitant diseases, the patient is recommended examination by a nephrologist, cardiologist, endocrinologist. The conclusion about the possibility of Palomo surgery is issued by related specialists or therapist.
At the time indicated by the doctor, the patient with the results of the tests should appear at the medical institution.
On the eve of surgery (in the evening), you need to carry out hygiene procedures - go to the shower, remove the hair on the stomach, in the groin. On the day the operation is scheduled, you should refuse food.
If the intervention is performed under local anesthesia, there are no restrictions on the use of water.
All about the analysis before the operation: what you need to take, why, important nuances.
Operation Palomo is highly traumatic. Therefore, it is carried out in stationary conditions: in the urological (surgical) departments of the hospital.
Surgical intervention is performed by an andrologist or a urologist surgeon together with nurses. The course of the operation, the condition of the patient during his stay under anesthesia is controlled by the anesthesiologist. If necessary, resort to the help of other specialists - phlebologist, cardiologist.
Palomo's operation begins with the introduction of an anesthetic. After he acts, proceed to remove the varicocele.
|Stages of the operation Palomo||Essence|
|Tissue incision||Disinfect the skin, cut it and subcutaneous tissue, retreating 3 cm up from the inner ring of the inguinal canal. Cut length - up to 4 cm|
|Removal of affected vessels||Muscle tissue is cut along the fibers, pushed to the sides and fixed with clamps. The bare testicular vein and artery are fixed, ligated, cross|
|Stop bleeding||Massage the scrotum, remove the resulting venous and arterial blood, wash and dry the wound, coagulate the vessels|
|Stitching||Fabrics are sutured in layers using an absorbable or special thread. If necessary, drainage is left in the wound|
The final stage of the Palomo operation is the application of a sterile dressing to the suture. On average, surgery lasts 30 minutes.
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.
The duration of the rehabilitation period after Palomo surgery is from 2 to 4 weeks. During this period, it is necessary to wear tight underwear, refuse sex.
Full recovery occurs in 3-6 months. Before the end of the rehabilitation, it is recommended to abandon:
- Strength training.
- Hiking in the sauna, bath.
- Long stay outside in cold weather.
- Reception of a hot bath.
- Weight lifting.
- Perform exercises related to the tension of the abdominal wall.
It is possible to resume sexual life 3.5 weeks after Palomo’s surgery, but only after prior consultation with a doctor. First, during intercourse, pain in the scrotum may occur. Uncomfortable sensations disappear, and reproductive function is fully restored after regular sexual activity has been established.
Rehabilitation after surgery: useful tips, tricks, answers to frequently asked questions.
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.
With Palomo surgery, access to the testicular vein is more free and open. This allows you to reduce the risk of recurrence of varicocele associated with the remaining unnoticed affected branches of the vessel. But the recurrence rate of the pathology after surgery using the Palomo technique remains high - 25%.
The price of Palomo surgery depends on:
- Type of anesthesia.
- Geographical location, ownership of a medical institution.
- The degrees of varicocele.
- Duration of hospital stay.
- Postoperative care rates.
- Qualifications of the operating surgeon.
The cost of surgical intervention in the capital of Russia is from 22 thousand rubles. In public institutions, the price of Palomo surgery is lower than in private clinics. But choosing a venue, it is recommended first of all to pay attention to the qualifications of the doctor.
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.
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.
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.
Operation Ivanissevich and Palomo with varicocele: indications, operation, advantages and disadvantages of both techniques
Scrotal Vein Dilation or spermatic cord, doctors call varicocele. This disease usually develops during adolescence and may not manifest itself for a long time, but when a patient develops pain in the testicle or bumps appear on the scrotum, then surgical treatment is required. Depending on the degree of the disease, doctors perform an operation of Ivanissevich, Palomo or Marmara.
Causes of the disease
Veins are tubes with valves located inside that impede the return flow of blood. Sometimes one-way sashes do not cope with their duties. Then there is a counterflow. Blood begins to accumulate in the vein, which leads to its increase in size. This process is called varicose expansion.
The testicles of a man are braided by a system of the thinnest veins, which in medicine is called the cluster-like plexus. From there, blood enters a larger vessel, from which it flows into the renal or inferior vena cava. The direction of blood flow depends on the testicle: left or right.
The pressure in the renal vein is much higher, so the left testicle veins most often undergo varicose expansion.
Varicose veins the left testicle often causes infertility in men. This is due to an increase in temperature in the testicles due to stagnation of blood. Elevated temperature disrupts spermatogenesis. Sperm cells are produced significantly less and their motility is greatly reduced.
Male infertility with the expansion of the veins of the testicle can be reversed. To do this, you just need to do a varicocele operation.
This disease occurs for several reasons. Depending on them There are 2 types of varicocele:
- Idiopathic or primary disease occurs due to a hereditary predisposition. Most often, it manifests itself during puberty, when a man completes the formation of the reproductive system. At this time, the genitals require more blood, which causes the veins to work under excessive load. It is this that causes the expansion of the vessels of the plexiform plexus.
- Symptomatic or secondary disease can develop due to increased intra-abdominal pressure and heavy physical exertion associated with playing sports. Secondary varicocele can also develop against the background of squeezing veins that remove blood from the testicle, cyst, tumor, or other formation behind the peritoneum.
Primary pathology is detected much more often than secondary. But in both cases, the patient learns about it, only after the first symptoms appear, when surgical treatment is indispensable.
Indications and contraindications for surgical treatment
When planning an operation, the doctor must take into account the patient’s desire to have children in the future, the age of the patient and the general condition of the body. Further, the severity of the disease is determined. He has 4 stages, which identified by the following symptoms:
- Varicose veins can be seen on an ultrasound scan.
- The veins of the plexus plexus are clearly palpated when the patient is standing.
- Deformation of the veins is determined at any position of the patient.
- Enlarged veins are visible to the naked eye.
Most surgeons insist that conservative treatment is not effective. It is necessary not to waste time and conduct surgery at any stage of the disease in order to exclude itself chance of infertility.
Indications for surgical intervention are:
- The process of spermatogenesis is severely impaired. This is determined by the number and motility of sperm in the seminal fluid.
- The patient is not satisfied with the appearance of the scrotum. There are mounds on it.
- The patient suffers from a pain syndrome, which increases with physical exertion and prolonged walking.
- Reducing the size of the testicle.
Surgery is carried out only after how will the patient turn 18 years old. In this case, the risk of relapse is minimal.
When doctors revealed a secondary varicocele, then treatment is possible only after eliminating the primary disease.
There are the following contraindications for surgical treatment:
- Diabetes or cirrhosis in the stage of decompensation.
- Acute inflammatory processes.
- The presence of large anastomoses between the vessels.
- Increased pressure in neighboring veins.
Endoscopic surgery cannot be performed if the patient has previously undergone surgery in the abdominal cavity. The fact is that the clinical picture after abdominal surgery will be changed. This can lead to erroneous actions of the doctor.
Regardless of the chosen surgical technique, the patient is prepared in advance for the procedure. At least 10 days before surgery, the following diagnostic measures are performed:
- Blood test for general and biochemical parameters, sugar, coagulation level and group.
- Chest x-ray.
- · Electrocardiogram.
- A blood test for HIV, hepatitis and syphilis.
It may also require an ultrasound of the scrotum with the introduction of a contrast agent into the venous bed. This allows the doctor to assess the condition of the vessels.
On the day of surgery, the patient should not drink and eat. The patient should take a shower on his own and carefully shave his stomach and pubis.
If before that the patient was taking any medications for the treatment of chronic diseases, then he should notify the attending physician about this. Some drugs can increase the rehabilitation period after surgical treatment of varicocele.
Types of operations
Types of surgical intervention differ by the method of access to the vessels and the execution technique. Taking into account the second feature, all operations are divided into 2 groups:
- Doctors preserve reno-caval anastomosis.
- Surgeons excise him.
Currently, doctors prefer to excise a reno-caval shunt, since this technique is considered the most effective.
Sclerotherapy for dilated vessels
This operation is considered to be less traumatic, so for its carrying out there is no need to put the patient in the hospital. She is done in an angiography room under local anesthesia.
After anesthesia, the doctor punctures the skin and then inserts the needle into the right femoral vein. Next, a probe is introduced, allowing you to enter sclerosant into the desired vessel.
For sclerosis, a 3% thrombovar solution is most often used. After soldering the necessary vessels, a contrast medium is injected into the vein. If varicose veins on ultrasound is not observed, then treatment is considered effective. The doctor removes the probe, and a dressing is applied to the puncture site.
Doctors do not favor sclerotherapy. After this procedure, there is a high probability of the return of the disease after several years. Usually sclerotherapy is done at the initial stage of varicocele.
It is performed under general or local anesthesia. In some cases, doctors use epidural anesthesia.
After anesthesia, the doctor punctures the abdominal wall in the navel and inserts a trihedral needle through which gas is pumped over the peritoneum.
After that, a laparoscope connected to the camera and the lighting system is inserted into the puncture. The device allows you to control all manipulations in the abdominal cavity.
Under the control of the camera, another 2 punctures are made in the abdominal wall. One above the bosom, the second in the iliac region. Through them, the doctor gains access to the arteries and lymph vessels. The vessels affected by varicose veins are tightened, after which the peritoneum is sutured. Punctures are closed with special dressings.
How much the patient will be in the hospital after surgery depends on the anesthesia applied. After local anesthesia, the patient can go home the very next day. In other cases, the patient will have to spend in the hospital from 3 to 7 days.
This is the most advanced type of therapy. Laser treatment of varicocele allows to exclude infection of the wound surface, as well as to avoid bleeding, because the beam immediately seals the damaged vessels.
During laser operation the patient is given only local anesthesia.
During the procedure, doctors do not make large incisions. Using a needle, catheter and intravascular endoscope, they gain access to the dilated vein. Then, by means of fiber optics, a laser beam is applied to the expansion region. The laser causes coagulation of the vessel and it will turn off from the bloodstream.
After laser treatment, there are no complications, so the rehabilitation period takes very little time.
The patient can go home half an hour after the operation is completed.
The technique of performing this procedure is considered classic. Its essence lies in the dressing of varicose veins. In this case, the doctor retains all the lymphatic vessels.
To gain access to the vessels, the doctor makes an incision above the pubis. Then, using surgical instruments, he separates the muscles to gain access to the venous plexus. There, the surgeon separates the lymphatic vessels and temporarily isolates them. The dilated veins are ligated. The operation ends with suturing the wound and applying a bandage.
The operation according to Ivanissevich has been used by doctors for more than half a century, but it cannot be called ideal. The fact is that after such an intervention, patients may develop dropsy of the testicle. Relapses are also common.
Video: operation on Ivanissevich
Varicose veins are considered a serious disease that does not respond well to conservative therapy. Particularly serious consequences are observed with the development of pathology in men, when there is a violation of the outflow of blood and damage to the vessels in the field of the plexiform plexus of the testicle. Due to the absence of symptoms at an early stage, the disease is detected much later, and conservative therapy does not have the desired effect. The only way out of the situation is surgical treatment.
What you need to know about varicocele
Varicocele is a term that determines the pathological expansion of the vessels of the spermatic cord, which form the vascular plexus of the testis. It is caused by a violation of the venous outflow and blood stasis. In the early stages, the disease is not dangerous, but a progressive process can lead to more dangerous consequences - infertility and tissue necrosis.
Varicose veins in men are manifested mainly in the period of 15-25 years, when there is an active growth of the body and the formation of the reproductive system, but as practice shows, a violation can occur in a child at an earlier age.
The onset of the disease can be determined by the relief venous network under the skin from the side of the lesion. As the testicle progresses, the testicle decreases in size, and the scrotum sags. The patient complains of sharp or dull pain, bursting and discomfort. In case of deterioration of health, the doctor raises the issue of surgery.
Surgical treatment of the disease by the method of Ivanissevich
Modern surgery has many different methods of treating varicocele. However, against the backdrop of highly effective minimally invasive and endoscopic surgeries, the Ivanisevich technique proposed in the last century still continues to be popular. This is due to a simple implementation technique and affordability, since the costs of the operation are covered by the insurance policy. In addition, this type of intervention is put on stream, so every specialist is able to perform it.
But, despite this, there are many advantages that allow you to perform operations using this method.
Description of the method and its advantages
The essence of the method of surgical treatment according to Ivanissevich consists in ligation of the testicular vein at the level of the retroperitoneal department and its resection. The goal is to eliminate the main problem - the removal of a vessel that is unable to provide blood outflow and leads to an increase in temperature in the testicle.
The popularity of the operation is due to a number of undeniable advantages:
- the ability to treat at any stage of the disease,
- accessibility of performance at any age, except for children under 13 years old,
- extremely low risk of complications,
- simplicity of technical performance and affordable cost.
With moderate varicocele, doctors can perform an operation using the Palomo technique. It differs from Ivanissevich’s technique in a higher incision. It is done where the vein of the testicle comes out of the plexiform plexus. Together with the selected vein, the artery of the testicle is bandaged.
The advantage of this method is to reduce the likelihood of relapse. At the same time, the Palomo operation has a significant drawback: due to artery ligation and a violation of blood supply, the testicle may atrophy.
In addition, the invisibility of the lymphatic vessels leads to their damage during surgery. This usually goes unnoticed by the patient, but sometimes it can cause problems with lymph outflow, which manifests itself as a hydrocele.
The essence of the operation
There is a varicocele due to increased pressure in the veins of the scrotum or valvular insufficiency in the veins of the testicle. Men usually experience aching pain in the affected area, notice changes in the venous pattern on the penis. The disease develops in four stages. The doctor can diagnose it only on the second - when the veins begin to be palpated by the hands, and sometimes even noticeable during examination.
During the operation of Ivanissevich, ligation and intersection of such a varicose vein (or veins) is performed. In this regard, the reverse outflow of venous blood down the testicular vein stops.
Grounds for the operation
Surgery for varicocele according to Ivanissevich is performed in most Russian clinics. It is carried out both for adult men and for children and adolescents. The only and main indication for surgery is varicose testicular veins of varying severity.
The timing of the procedure and its feasibility is determined individually by the attending physician based on the results of the examination and the patient's condition. Opinions regarding the timing of varicocelectomy often differ. Some argue that delay can be detrimental to the well-being and life of the patient, leading to infertility. Others believe that there is no threat, since even a successfully completed operation is not a guarantee of improving spermogram indicators and other analyzes.
Prohibition of treatment in this way
Like any surgical procedure involving invasive intervention in the form of cuts and sutures, varicocelectomy has a number of limitations and prohibitions:
- blood diseases, including hemophilia,
- chronic disorders in the acute stage,
- inflammatory processes of any etiology,
- genitourinary infections
- oncological diseases,
- severe decompensated pathologies of internal organs,
- purulent-inflammatory lesions of the skin.
Surgery is contraindicated in case of high temperature or general weakening of the body.
To perform the operation using this technique, the doctor does not need to penetrate the patient’s abdominal cavity. This means that the number of postoperative complications is significantly reduced.
The progress of the operation is as follows:
- A doctor using microsurgical instruments gains access to the spermatic cord.
- Using a microscope, the surgeon isolates the spermatic vein and bandages it.
- The instruments are carefully removed and the wound is sutured. At the same time, the seam remains almost invisible.
After the operation by the Marmara method, the patient does not need hospitalization, so doctors let him go home after a few hours, necessary to monitor the condition. Rehabilitation of the patient lasts 2 days.
The patient is advised not to exercise or lift weights for two weeks after surgery.
Preparing the patient for the procedure
The preparatory preoperative stage is not much different from the standard procedure for other surgical interventions. To confirm varicocele in relation to the patient, a detailed diagnosis is carried out - tests of biological fluids, a number of other laboratory tests are prescribed:
- on sex hormones
- genital infections - STIs.
The list of mandatory manipulations includes:
In the presence of any acute infections or other pathologies, it is necessary to consult a therapist, an urologist andrologist, an anesthetist's opinion (if general anesthesia is planned). On the eve of the scheduled date of surgery, the patient should:
- take a shower,
- shave the hair on the abdomen and groin,
- to prepare comfortable linen.
The last time to eat should be no later than 22 hours. In case of anxiety and insomnia, it is recommended to take a tablet of a light sleeping pill or tranquilizer.
Stages of surgical procedures
Ivanissevich’s operation for varicocele is distinguished by a simple technique and is performed using local anesthesia. In relation to emotionally labile patients, as well as children and adolescents, it is advisable to use general anesthesia. You must come to the hospital on the appointed day half an hour before the procedure. You should have an identity card (passport) and the results of the examination with you.
The operation itself consists of several stages:
- Excision of the abdominal wall.
- Isolation of the testicular vein, its ligation and resection.
- Checking hemostasis and suturing wounds.
- The patient is laid on his back, an anesthetic is administered.
- The operation begins with an incision of about 50 mm in the iliac region until it comes into contact with the veins. The skin is dissected longitudinally on the left side.
- Next, a visual assessment of the condition is carried out, which is especially important at the 3-4 stage of the disease.
- After that, he begins to cut all tissue structures, including the wall of the inguinal canal. The spermatic cord is located inside and the vessels affected by varicose veins are also found here.
- The cord is pulled into the wound and the dilated vein is separated, which is securely fixed and clamped in two places. It is excised and ligatures are placed on fresh sections - special threads.
- This is done with all the vessels, regardless of the size, which they managed to bring out.
- After the procedure, the doctor checks the correctness of the resection and the presence of unexcited vessels.
- At the end of the check, he proceeds to the gradual closure of the wound. To do this, he begins to connect all the layers that have been dissected.
- At the final stage, treatment with disinfectants is carried out, and a sterile dressing is applied to the wound.
After any of these operations, the male body needs some time to recover. To improve spermatogenesis, the following drugs are prescribed to the patient:
- Dietary supplements with zinc and selenium.
- Hormonal drugs. Their patient should be taken only under medical supervision.
In the first days after the procedure, the patient should rest more and work less. Sex and sports are delayed for at least two weeks. Also, it is forbidden to take a bath and visit the sauna during the week after surgery.
The possibility of a return to sexual life is determined by the doctor after the examination. Otherwise, a man may encounter pulling sensations during intercourse.
After the operation is completed, the patient is transferred to the ward for further observation and an ice bladder is placed on the seam site.
- To minimize pain, pain medication is prescribed, and in order to prevent the development of infection, a course of antibiotic therapy is prescribed.
- Over the next 3-5 days, the patient is prescribed bed rest, the health worker is prescribed to change the dressing daily.
- For a week or ten days, it is recommended to wear a suspension - a special bandage to maintain the testicles and prevent stretching of the spermatic cord.
- At the time of discharge, it should be replaced by tensile swimming trunks, which should perform the same supporting function, without causing discomfort.
- Suture removal is done in the second week. The day the doctor chooses, based on the well-being of the patient, the healing process and the condition of the skin.
- Physical activity is prohibited for six months from the date of the operation.
- It is recommended to refrain from drinking alcohol and smoking.
In their reviews, most of the operated men complain of pain, which is difficult to eliminate even after taking painkillers. Typically, these symptoms persist for 30 days, although in some cases they last for 3-4 months.
According to the patients themselves, this is due to non-compliance with the recommendations of the attending physician, the absence of a sparing regime and increased physical activity. Quite rarely, these manifestations are the result of the wrong tactics of the surgeon during the operation.
Some patients report the appearance of edema in the area of the surgical incision, which is considered the norm with these types of interventions. It does not cause discomfort and disappears in the first two weeks of the postoperative period.
Comparison with other operations: prices, features
The operation according to the Ivanissevich method is recognized in the territory of the Russian Federation as the most affordable and inexpensive compared to such types of open surgery as Palomo and Marmara surgery.
As a rule, the costs of its implementation are covered by an insurance policy. But in this case, prices may vary depending on the institution, its status and prices for services.
The cost of the procedure on average ranges from 25-30 thousand rubles. However, in a private clinic with all the amenities, examination, and specialist advice, surgical treatment will cost 40-44 thousand rubles.
Prevention of repeated varicocele
In order to prevent the development of repeated varicocele or after surgery on one of the testicles, it is recommended:
- Have a regular sex life, but do not overdo it with sex.
- Take drugs that thin the blood, and prevent the development of congestion.
- Lead a healthy lifestyle, actively move and engage in sports (light types).
- Refuse bad habits (alcohol, smoking), if possible - forever.
- Adjust your diet by enriching it with healthy nutritious foods.
- Regularly perform a set of exercises to recover and prevent relapse.
- Every 6 months to be examined by a doctor.
The operation according to the method of Ivanissevich is considered quite effective and inexpensive, but at the same time a traumatic option for the surgical treatment of varicocele with a long (and in some cases painful) period of rehabilitation. Before making a final decision on the choice of this method of eliminating the problem, it is necessary to consult with a specialist, to study possible offers coming from other clinics. If there is no alternative, you should undergo a diagnostic examination and rely on the competence and professionalism of the surgeon.
In the later stages of varicocele, surgical intervention is required. There are several methods of surgery to eliminate this pathology. One of them is the operation of Ivanissevich with varicocele.
In the article we will tell:
Varikotsele: the progress of the operation Ivanissevich
Varicocele is a varicose vein inflammation of the epididymis and spermatic cord. This pathology is quite common, the most susceptible to the disease are boys undergoing puberty. The disease is treated exclusively with surgery.
Today, in the territories of the post-Soviet space, the operation is most often used according to the technique proposed by Ivanissevich back in 1924, in whose honor it was named. It is simple and for quite a long time was considered the main way to remove varicocele until minimally invasive techniques began to appear with less risk of relapse. Today, surgeons prefer this technique less and less.
However, as before, in the vastness of our country, in the overwhelming majority of state clinics, treatment for HRV is carried out according to the Ivanissevich technique. This article will allow you to learn more about when the Ivanissevich operation is used for varicocele, the technique and all the features associated with this generally recognized way to eliminate venous pathology.
What does a varicocele look like?
In this article you will learn:
Varicocele according to Ivanissevich: preparation
Preparation for surgery is different from what other operations require. First you need to go through the examination and pass all the necessary tests.
A prerequisite is a conclusion after an ultrasound or dopplerography.
In addition, tests are also required for:
The absence of other operations greatly simplifies the preparatory process, since fewer analyzes are required. The type of operation is chosen by the doctor on the basis of all tests and the patient’s health status, so prior consultation will also be a prerequisite.
Most often, this procedure is performed under local anesthesia. In exceptional cases, it is possible to carry out with full anesthesia, if the patient can withstand it. Before surgery, you need to take a shower and get rid of pubic hair. Eating before the operation should take place the day before it, no later than 22 hours. To calm the condition, you can use sleeping pills at bedtime.
Technique of operation Ivanissevich and Palomo with varicocele
Scrotal Vein Dilation or spermatic cord, doctors call varicocele. This disease usually develops during adolescence and may not manifest itself for a long time, but when a patient develops pain in the testicle or bumps appear on the scrotum, then surgical treatment is required. Depending on the degree of the disease, doctors perform an operation of Ivanissevich, Palomo or Marmara.