OPEN APPROACH VERSUS MINIMALLY APPROACH FOR THE TREATMENT OF VARICOCELE IN CHILDREN - AN EPIDEMIOLOGICAL STUDY

Aim: The therapeutic indication of varicocele and the best method of treatment in children are still subjects of extensive debate in the literature. The purpose of the present study is to compare two of the most frequently used methods of treatment, both in terms of patient evolution and in economic terms. Material and methods: The observation charts of 69 patients with varicocele, who were hospitalized in the Pediatric Surgery Clinic of the “Saint Mary” Children’s Emergency Hospital, have retrospectively been analyzed for a period of approximately 4 years. Three groups of patients have been created depending on the method of treatment - 25 cases operated by laparoscopic approach, 28 cases where the classical approach was used and 12 cases where surgery was denied or delayed. The demographic data, the duration of the surgery, the duration and the cost of hospitalization, the complications and the relapse rate have been compared statistically. Results and discussion: Patients mainly came from rural areas (73.8%), with an average age of approximately 14.5 years. The difference in weight of 54.7 / 53.5 kg between the group treated classically and the group treated laparoscopically was insignificant (p=0.76). The total duration of hospitalization and the postoperative duration of hospitalization were slightly higher in the group treated laparoscopically (5.24 / 4.28 days and 2.08 / 1.82, respectively), but the differences were not statistically significant (p=0.13 and 0.29, respectively); yet, the duration of the surgery was significantly higher (p=0.002) in the group treated laparoscopically (73.0 / 57.32 minutes). In terms of relapse, the postoperative progress was comparatively similar - only one patient in both groups relapsed and then was addressed by the other technique. However, regarding the rate of the postoperative occurrence of the hydrocele - a well-known complication following the surgical treatment of varicocele - it has not occurred in any patient treated classically, but it occurred in four patients treated laparoscopically (16%). Both the overall hospitalization costs (1,818/1,999 RON - classical / laparoscopic approach) and the costs divided on medication, sanitary materials used and medical tests were similar. Conclusions: The treatment of varicocele by laparoscopic approach began to be practiced in our clinic about four years ago, and although it is still being perfected (long duration of surgery and long duration of hospitalization), the results are encouraging.