Marmara microsurgery is a type of surgical intervention for the treatment of an ailment called varicocele. It is prescribed by a urologist if a vein of the sphenoid plexus of the testicle (varicocele) is detected, when the patient complains of discomfort in the scrotum, or when there is a noticeable decrease in the size of the testicle, a decrease in its function.
The advantages of Marmara surgery over other methods of combating varicocele
Marmar's operation every year an increasing number of doctors recognized as the most effective and reliable method of treatment for varicocele. The main advantages are:
- in the smallest number of relapses, which becomes possible thanks to microsurgical glasses and a microscope that allow you to process the smallest veins;
- to a small degree of tissue trauma;
- in a small and inconspicuous scar measuring no more than 2 cm;
- in the almost complete absence of pain after surgery;
- in improving the quality and quantity of sperm;
- the ability to quickly return the patient to a normal lifestyle.
A few more differences of operational methods according to Ivanissevich, or laparoscopy, from the Marmar method. The Ivanissevich operation involves the dissection of the aponeurosis, which can lead to trauma to the muscles of the anterior abdominal wall, increasing the rehabilitation period and intensifying the postoperative pain syndrome. The Marmar operation allows you to cope with both left-sided and right-sided varicocele. And the improvement of spermatogenesis and fertility assessment can be carried out after 6-9 months. Most men after surgery according to Marmara in the next few years have the opportunity to become fathers.
What are the indications for the operation of Marmara
The main and, in general, the only indication when Marmara surgery is prescribed is considered to be varicocele - a disease that can occur without pronounced clinical manifestations, it is almost asymptomatic.
But often, turning to specialists for help, patients complain of severity in the scrotum, pain in the testicle. The examination reveals deviations in the spermogram, which indicates a violation of sperm production by the testes. Non-surgical treatment of the disease is impossible, especially if it comes to complications that can cause infertility. The operation of Marmara with varicocele, according to world statistics, allows you to fully restore the reproductive function of the organ.
Varicocele: what is it, what is fraught
The disease involves the expansion of the veins of the testicles of the spermatic cord, which is associated with a malfunction of the check valves located in the veins. That is, a healthy valve provides blood flow through the vein in only one direction, damage to the valves does not allow them to inhibit the return of blood. Any increase in pressure leads to the fact that the blood tends to return.
The causes of the disease
Varicocele may be a manifestation of:
- congenital malformation of venous valves ;
- congenital weakness of the vascular wall;
- increased pressure in the pelvis or scrotum, which leads to kinking, changing shape and gradual compression of the veins.
To correct such a pathology, there are many different methods, for example, an operation according to Ivanissevich or a laparoscopic method. Why did the Marmar method become popular? The operation virtually eliminates the possibility of damage to the muscles of the abdominal wall, damage to the arteries of the testicle, the occurrence of inflammation.
Contraindications for Marmara surgery
As with any surgical intervention, even the most effective and safe procedure may have contraindications:
- stage of exacerbation in chronic pathologies of internal organs;
- the first six months after a stroke, heart attack or other coronary heart disease;
- inflammatory processes in the genitourinary system;
- flu, acute respiratory viral infections and other infectious diseases.
How to prepare for the intervention
Marmara’s operation and preparation for it involves a standard amount of research: general, clinical and biochemical blood tests, coagulograms, ECG, RW tests, syphilis, HIV, hepatitis, an anesthetist examination on the eve of the operation.
Preoperative examination can be expanded or, conversely, reduced depending on the amount of the planned intervention, age and general condition of the patient.
Immediately before the operation, you should:
- Shave off hair, if any, in the upcoming area of operation. This should be done carefully, without cutting the skin and causing further irritation.
- Some doctors practice the appointment of anti-inflammatory or antibacterial therapy, which reduces the risk of inflammation in the invasive area. Acceptance of drugs begins a few days before the operation.
- General anesthesia or spinal anesthesia involves the last meal no later than 10 pm. The day before the operation is not allowed to eat, drink, smoke. In the evening on the eve of surgery and in the morning on the day of surgery, a cleansing enema is done.
- Local anesthesia does not require fasting or a cleansing enema.
- Reception of anticoagulants should be stopped 5 days before the upcoming operation. Instead, they are prescribed drugs of low molecular weight heparins, which reduces the risk of surgical or postoperative bleeding.
Marmara’s operation with varicocele, reviews of which testify to the high efficiency of the method, allows you to restore venous current and prevent the outflow of blood poisoning the testicles. Postoperative relapse occurs only in 5-7% of patients.
Types of anesthesia: which may be, which is more preferable
Marmar surgery can be performed under general anesthesia, which, like other types, is performed by an anesthesiologist, while the patient falls asleep and wakes up after the operation is completed.
Spinal anesthesia anesthetizes the entire lower half of the body. An injection is made in the region of the spinal column.
Local anesthesia will anesthetize only the invasive area, while the patient will be conscious, but the pain will not be felt. In recent years, more and more doctors prefer the local type of anesthesia.
How is the operation
The operation begins with the surgeon dissecting the skin of the sub-inguinal region, making an incision of 1.5 - 2 cm in size. There is a spermatic cord, which for convenience is displayed in the wound. Using a microscope, the surgeon isolates the testicular veins and bandages them. Doctors prefer to use local anesthesia, as the patient can be asked to breathe and tighten, which allows the doctor to better see everything, even the smallest, dilated veins and venous branches. The microscope allows you to make the process of dressing as correct as possible, without the herbs of nearby nerves, lymphatic vessels and arteries. After suturing all the veins on the wound, a rubber graduate is drained. After that, an aseptic dressing is applied to the site of the incision.
Surgical intervention lasts for 30-40 minutes. After which the patient is transferred to the postoperative ward, where he remains for several hours under the supervision of a doctor. After two hours, after assessing the patient’s condition, the doctor can let him go home.
Postoperative period
The rehabilitation period after Marmara surgery is minimal. It will be necessary to come to the dressing only a few times if it is not possible to carry out the procedure at home. After several days, the patient can fully return to his usual way of life. True, it is recommended to refrain from sexual relations, from lifting and carrying weights and playing sports, so that the integrity of the seams is not violated. This is confirmed by patient reviews. Sutures are removed after 7-8 days. A small scar will be located below the line of wearing clothes, in the area where the hair grows, so that it remains invisible. Marmara’s operation, reviews of which are extremely positive both from patients and from doctors, does not cause testicular atrophy, dropsy, or any other complications that can be expected from other types of surgical intervention. This operation allows you to restore and prevent further expansion of the veins, improve sperm quality.
According to many men, Marmara surgery is a quick and effective method of getting rid of varicocele, which allowed them to avoid postoperative complications, pain, discomfort and ugly scars.