The Marmar operation
The Marmar operation, also known as microsurgical subinguinal varicocelectomy, is considered the primary and most advanced method of surgical treatment for varicose veins of the testicles, known as varicocele. This technology ensures high effectiveness, particularly in restoring reproductive function, with a low risk of recurrence (less than 1.8%). Moreover, it can typically be performed in a single day due to its minimal recovery time requirement.
Most men suffering from varicocele seek medical attention late, when the only effective remedy to restore reproductive health is surgery. Not all men with varicocele are infertile, but the condition is considered a cause of fertility disturbances in 20-80% across various statistical groups.
During the intervention, the doctor extracts damaged veins and carefully ligates them. As a result, blood circulation normalizes, stasis of blood in the testicles is eliminated, and sperm parameters improve to a level where conception becomes possible. In some cases, couples may resort to assisted reproductive techniques (ART), but many are able to achieve fertilization naturally.
OUR RESULTS
Indications for intervention
A poor surgeon is one who does not take all measures to prevent surgery before prescribing it, because any invasive procedure, even minor, always carries some risks. The primary indication and sufficient reason for microsurgical varicocelectomy is prolonged infertility (more than a year) with a confirmed diagnosis and abnormalities in sperm analysis that prevent conception. These include:
Not every varicocele leads to such disturbances, not every one has pronounced pathological symptoms (many patients do not feel any discomfort at all), and not everyone desires to have children.
If the condition does not manifest itself in any way, surgery is not necessary — however, such patients rarely seek medical attention.
- 5 million sperm per milliliter and teratozoospermia. It all sounds very daunting, especially the last word."
Yes, the patient is not feeling well. In simple non-medical terms, this means there are very few sperm in the ejaculate, and many of them are of abnormal, deformed shapes. This explains why the couple has been unable to conceive despite numerous attempts — with such parameters, the chance of spontaneous pregnancy is only a couple of percent. Fortunately, the man is still young, and the situation is likely reversible.
-As I mentioned before, the ultrasound showed a pathology — varicocele. Surgery is recommended for you.
-Can we try to improve the situation without surgery? Take vitamins, do some exercises? The idea of surgery on the scrotum is frightening. Could there be complications that would make things worse?
This question is well researched. Varicocele is observed in at least 15% of men worldwide, and believe me, undergoing surgery as soon as the pathology is diagnosed is the optimal choice. The risk of complications is very low, and patients typically recover quickly.
-What exactly happens?
Pathologically dilated veins are tied off, thereby normalizing the blood supply to the testicular tissues. I will r: "make a small incision right here, look at the diagram...
-Is this like laparoscopy?
No, this is microsurgery. The scar heals quickly and is almost unnoticeable afterwards, about a centimeter in length. The advantage of minimally invasive techniques is that there is no risk of damaging lymphatic ducts or arteries, so there won't be any disruption of lymph flow or other issues.
-Will I be cured of oligozoospermia, asthenozoospermia, and even teratozoospermia?
With a high probability. Many of the men I've operated on have become fathers within a year and a half to two years.
-Will I be able to work after varicocele removal?
If your work is physical, you can resume in about a week. There will be some limitations in the first month — avoid extremely heavy lifting and wear supportive underwear. You may experience moderate pain for the first couple of days, but painkillers can be taken. It won't be too painful. Can you plan your activities to ensure you have a week or so of rest?
-I think so, yes. Can varicocele recur?
There is a small risk of recurrence, unfortunately, even if all recommendations are followed perfectly. However, it is indeed very low. Complications in my experience are very rare, despite having performed surgeries for a long time.
-Can we schedule the date now?
Almost. First, you'll need to undergo a few tests — then we can set a date right away.
Advantages of microsurgical technique:
Microsurgical varicocelectomy is considered the gold standard in the treatment of varicocele. It is significantly more effective than earlier methods, and the use of a microscope allows for extremely precise manipulations. This eliminates the risk of injuring nearby arteries supplying the testicle, the spermatic cord, lymphatic vessels, and nerve endings.
Other Advantages of the Marmar Operation
compared to 10-37% for non-microsurgical operations according to various sources
whereas other operations like laparoscopic procedures have a risk exceeding 7%
After healing, only a barely noticeable scar of 1.5 cm remains
Low risk of bleeding, post-operative pain; patients describe maximum discomfort as minor discomfort
Already after a week, a man can return to his preoperative level of daily activity, and after 1-2 months - to sports
Features and Progress
Extended hospitalization is not required for the Marmara operation—patients typically spend no more than a day in the clinic. Within a few hours after the procedure, patients can start to get up. Prior to the intervention, a series of examinations and laboratory tests are necessary to assess the patient's condition, detect hidden pathologies, and ensure the safety of the operation. Patients should refrain from eating at least 6 hours before the planned procedure
Rehabilitation Period
If the procedure was performed under spinal anesthesia, patients are advised to rest for a few more hours. Typically, if the patient's condition is satisfactory the next day (which is usually the case), they can go home. The duration of hospitalization after general anesthesia depends on the patient's tolerance.
Within a week, patients can start to resume their normal daily activities. Some restrictions should be observed for 1-2 months after the surgery. It is advisable not to:
● Engage in vigorous sports activities, especially those involving strength training.
● Lift heavy objects.
During this period, it is important to regularly communicate with the treating physician to minimize the risk of complications.
The most common question men ask is when they can resume their sexual life. The minimum period of abstinence is typically about a week, but the pace of recovery is individual, and it's crucial to strictly follow the doctor's recommendations. A repeat spermogram is usually performed six months after varicocelectomy, by which time there is usually significant improvement.
Possible Complications
Generally, patients do not experience any negative consequences. However, rarely, the following complications may occur:
The Marmara operation offers very high chances that the patient will permanently overcome varicocele. Currently, microsurgery using high-precision equipment is the safest and most effective approach to combating male infertility caused by varicose veins in the testicles.
AVAILABLE TIME
