Igor N. Mironuk

Astana medical University, Republic of Kazakhstan, Astana

Simultaneous laparoscopic operations during correction of idiopathetic varicocele

Variance of opinions regarding surgical treatment of simultaneous abdominal pathology within simultaneous laparoscopic surgery requires further complex research work. Purpose of research is improving of results in surgical treatment of idiopathetic varicocele patients and simultaneous diseases of abdominal cavity organs. We have results of comparative analysis of data which were obtained at 69 simultaneous laparoscopic operations and 48 isolated laparoscopic operations. There were 3 groups depending on pathology nature and type of operative interference. The first group includes patients, treated by laparoscopic operations of Ivanissevich combining with laparoscopic herniorrharphy, appendectomy and adheziolyze (1 main group n=69). The second group includes patients treated by laparoscopic operations of Ivanissevich regarding idiopathetic varicocele (n=72). The group three includes patients, treated by isolated laparoscopic operations: herniorrharphy, appendectomy and adheziolyze (n=48).

We used common methods of research of clinical, instrumental and laboratory research which are applied in surgery regarding research of patient’s life quality. It was performed with adapted SF-36 Russian check-list.

Background of experience of isolated and simulated operations allows determining indications and contraindications to simultaneous laparoscopic diseases. Indication to performing of simultaneous laparoscopic operation is occurrence of two separate surgical diseases.

Common diseases include diseases and status of patient. Herewith, the justifiability of laparoscopic measure is doubtful as the effort of laparoscopic interference may lead to serious complications.

They are as follows:

a. pneumocardial abnormalities in decompensation stage;

b. abnormality of coagulating system;

c. evident commissural process in abdominal cavity.

Comparative analysis of operative intereferences performed by laparoscopic method allowed making an analysis that during simultaneous operations, continuity comprises of sum of continuity of isolated interference. In this result, component of operations time which is expendable for the creation of additional operative access was insignificant, or is not required during operations in one anatomy zone.

Analysis of motion activity of patients in comparative groups at postoperative period has shown that availability of simultaneous stage within laparoscopic operations does not influence considerably on dynamics of motion activity of patients.

Comparative analysis of patient is life quality subject to simultaneous operative interferences was made using SF-36 standard check-list in 3 months and 1 year after operation. Operated patients regarding simultaneous surgical pathology (simultaneous operations) has shown decrease of life quality,expressinq evident decrease of average values of indices of corporal pain,roles of emotional problems in limit of life quality of common health sensinq,indices of physical activity, and less,decrease of mental health and social activity.

The level of life quality abnormality during research of persons, caused by 1year before simultaneous operative interference was decreased as per indices of physical activity scale,corporal pain and role of physical problems within the limits of life quality.

When comparinq the results of health with the previous year, the results are increased that is an expressed pathologic influence of influence of implemented treatment on subjective indices of life quality.

Comprative analysis of economic activity of laparoscopic simultaneous operations has shown considerable economic efficiency of simultaneous operations has shown considerable economic efficiency of simultaneous laparoscopic operations. Total charges on treatment of patient, in case of two-staged operative treatment were 1,7-1,85 times more in the average, whereas durinq performing conducting of simultantous operation.

This conducted research shows that the use of simultaneous laparoscopic operation does not increase the level of aggressiveness, traumatism of operative interference, does not influence on the course and time of postoperative period in comparison with the isolated laparoscopic operations. It has a considerable economic effect (up to 35%) of total charges.